002612 (SATT)Building
Address 54-065 Oak H.I.
Owner
gkuv i a
P.O. BOX 1504 No.
78-105 CALLE ESTADO '
LA QUINTA, CALIFORNIA 92253
Mailing
Address'7.5_0lD,5,C0LWtXyCJt*Dr'Ve
City DeSaft ZipTel. '
Palm 0,226. 568~2,028 .. .
Contractor.
Address...
St�ltll�
.City - . - Zip Tel.
tr
State Lic.
& Classif. 2=31
Arch.; Engr.,
Designer
Address
City Zip
002612
BUILDING: ,TYPE CONST. OCC`'•GRP:• -
A.P.'Number
Legal Description
Project Description PIA WM. kg�SE 13 A
P1=40-'
City x i .1918
Lic. #328 sq: Ft. 928 No. No. Dw.
Size Stories, Units
New a Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel.
State
Lic: #
s V
LICENSED CONTRACTOR'S DECLARATION
'
I hereby affirm that I am licensed under provisions of Chapter 9'(commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.. ✓ ti {. �.
-
,. .. .. ... .. .. .. _ ..
SIGNATURE DATE
.,
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
_ reason:. (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure,' prior to its issuance • also -
.. requires the applicant for such permit to file a signed statement that.he is licensed pursuant to.; -
the provisions of the Contractor's License Law, Chapter 9 (commencing with .Section 7000) of.
Division3 o/ the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation -of Section 7031.5 by::any applicant for a permit
- subjects the applicant lo'a civil penalty o/ not more than five hundred dollars (8500). • '• `� f" ..
❑ I, as owner of the property, or my employees with wages as their sole compensation, will,..;
• do the work, and the structure is not intended'or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does. not apply to an owner o/ property who
Estimated Valuatic,
-���>.
- -- - • -
'PERMIT, - AMOUNT
- - -
Plan Chk.Dep... '
_ •-
Plarj Chk.- Bal. 395.60 _ t
Const: , , - 4 ' •
Mech. 14A fli�
+
builds or improves thereon and who does such work himself or'through'his own employees,
provided, that such improvements are not intended or offered for sale. If, however, the building
Electrical 7'g `
or improvement is sold within one year o/ completion, the owner -builder will have the. burden
of proving that he did not build or improve for the purpose o/sale.);. , .. -
Plumbing - t• •. 87-50 '
•
•0.1, as owner of the property, am exclusively contracting with licensed contractors to con-
., ,• struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does -not apply to an owner of property who builds or improves thereon, and who contracts /or
such projects with a contractor(s) licensed pursuant to the -Contractor's License Law.) -
•O I am exempt under Sec.. B. & P.C. for this reason
- -
S.M.I.- -- +' .. - - 830
Grading
Driveway Enc.
• Date Owner
Infrastructure 1,805.97.
' WORKERS' COMPENSATION DECLARATION
"
' I hereby affirm'thal I' have a certificate of consent to self -insure, or a certificate of
• Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) -
Policy No. ' ' ' ' Company
.. O Copy is filed with the. city. , .O Certified copy ishereby furnished.: ..
-
TOTAL 2.891.56
CERTIFICATE OF EXEMPTION FROM
• WORKERS' COMPENSATION INSURANCE
REMARKS
• • (This section need not be completed if the permit is for one hundred dollars (8100) valuation -
or less.) .. . ,- . ... .. ..
_ - I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person •in any manner so as to become subject to the Workers' Compensation
Laws of California.
-
Date-" Owner
NOTICE TO APPLICANT: I/, after making this Certificate of Exemption you should become
' subject to - the Workers Compensation provisions ofthe 'Labor Code, you must forthwith`
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY: •- '
Minimum Setback Distances:
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY..
hereby affirm lFiat there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)':'
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
'
FINAL DATE •INSPECTOR
Issued by:: Date Permit -
- - '
Validated by:
Validation:
A6435 9. 30
_ "
Lender's Address
' This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. • - I '
I certify that I have read this application and state that the above information is correct.
• I agree to comply with *all city and county ordinances and state laws relating to building
construction, and hereby authorize, representatives, -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant ✓ ff y }''r Date - • *r
s
Mailing Address Y n ` '
City, State,. Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ke SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
AS (ROUGH) t�
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ®c
BATH TUB
WATER HEATER
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GRADING
cu. yd.
$ plus x$
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR
SETBACK
GROUND PLUMBINGb
UNDERGROUND
A.C. UNIT
COLL. AREA
ke SLAB GRADE
ROUGH PLUMB./-?— ,?
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEP Iq
ROUGH WIRING ( 1 9
DUCT WORK
ROCK STORAGE
FOUND. REINF. O q r1.. S �p
AS (ROUGH) t�
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
LL REINF. STEEL /G i 1 -s
GAS (FINAL)
TEMP. POLE
\ GROUT
WATER HEATER
SERVICE
QOFINAL'NSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
„`FINAL INSP., / O
V
` l ROOFING Or. Cie
VENTILATION LyLL v �(
01 r!/O � ���
C l c
fpµ wA'q
1' 13/,��
1
6 1�13/�%
•
1045,
DA -1
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
,Q LATHING 3 ��
MESH
(1L INSULATIONISOUND, P
FINISH GRADING
FINAL INSPECTION t
U
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL