002610 (SATT)44
P.O. BOX 1504 No,�
Building 78-105 CALLE ESTADO
10
Address SA -4%t) rAiK J1'J LA QUINTA, CALIFORNIA 92253
Owner v
amrim
Mailing " BUILDING: TYPE CONST. OCC: GRP:
Address ? 05 (30antrV ClUbj.Ve A.P. Number
City Zip Tel.
ki;m -92260 568-2828 Legal Description
Contractor Project Description VIMPM,,i+
Address .�'??l .
aanmrs '
City . _ Zip Tel..
BMW
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Size GM • 424 • - Stories Units
Arch., Engr.,
Designer New Q Add ❑ Alter ❑' Repair ❑ Demolition.❑
Address Tel.
City Zip State
_ Lic. #
LICENSED CONTRACTOR'S DECLARATION
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.
iGNATl1RE "DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation
reason: (Sec. 7031,5,Business and Professions Code: Any city or county which requires a
peimil to construct, after, 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 PERMIT - AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of A.
Division 3 of 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, Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than live'hundred dollars ($500). Plan Chkgal. 7Y
❑ I, as owner of the property, or my employees with wages as their sole 'compensat ion, will . •
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const:'I
Professions Code: The Contractor's License Law does not apply to an owner of property who r
builds or improves thereon and who does such work himself or through his own employees, Mech. .
provided that such improvements are not intended or. offered for sale. If, however, the building -
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical
of proving that he did not build or Improve for the purpose of sale.) r1..4
•❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing t.sii
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 for S.M:I.
such projects with acontractor(s) licensed pursuant to the Contractor's License Law.)
Grading
.❑ I am exempt. under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure 3,276.00
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.. .
TOTAL I A 74..42
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation '
or less.) - - -
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to lhe'Workers' Compensation
Laws of California.
Date ' Owner —'
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
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.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 Date
Mailing Address
City, State, Zip
HARD COPYI
ZONE:
BY:
Minimum Setback Distances:
Front.Se.tback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property. Line
FINAL DATE
INSPECTOR -
Issued by:
Date 9-30,16 Permit
Validated by:
Validation:
A6440
9 30 i I %9,42 it
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEE
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SQ. FT.
WALL SQ. FT. ®
SO. 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
4GROUND
9
/ C SLAB GRADE 31-31OUGH
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
4ROUGH WIRING !I
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
AS (ROUGH)
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
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 & AIR COND. SOLAR
SETBACK
PLUMBIN O
UNDERGROUND
A.C. UNIT
COLL. AREA
4GROUND
9
/ C SLAB GRADE 31-31OUGH
PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPT�T
4ROUGH WIRING !I
1
DUCT WORK
ROCKSTORAGE
OIL/FOUND. REINF. �/1� �3 �
V
AS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL p
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
W.FINAL
INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
FINAL INSP.
6e FRAMING , 6
OOFINAL INSP.O`% /,% b�
1lO
IV ROOFING (',ISL/r! �
n G
O/C'� W fL,A/O 1�� 3 % J /
A ^� �' 7
'" d
�' �
f)
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�,o LATHING 'j S
MESH
1(4� INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL