002321 (SATT)Building
REMARKS
Address
-WORKERS'.COMPENSATION INSURANCE
Owner
Zip
State
Lic..#
Mailing
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. "\
Address
75-0
City
Palm Dam
Contractor
Estimated Valuation
a 120 J"4�
halu
Address..
Sam
City
State Lic.
& Classif. 288130
-Arch.; Engr.,
Designer
Address
Tel.
' I Tel...
'Icity
Lic. #
Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 402321
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Legal Description
Project Description � FILM 4 DR
Ph&%5A .
y�8 Sq. Ft. 1918 No.
Size M 424 Stories
New Q,. Add ❑" Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
CERTIFICATE OF EXEMPTION FROM
REMARKS
-WORKERS'.COMPENSATION INSURANCE
City
Zip
State
Lic..#
'
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. "\
I certify that in the performance of tha work for which this permit is issued, I shall not
_SIGNATURE" i ` � ` ..":r d`• � � DATE
r OWNER •BUILDER DECLARATION
I hereby affirm that I am exempt,•irom 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 licensedpursuant to
the provisions of the Contractor's• License Law, Chapter 9 (commencing- with Section 7000). of .a
' Division 3 of the Business -end -Professions Code, or thathe 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 to a civil penalty of riot more than five hundred dollars ($500): .:' . ' '"-
< ❑ I, as owner of the.property, or my employees with wages as. their sole compensation, will
do the work, and the structure is notintended or offered for sale. (Sec. 7044,.Buisness and
Professions Code: The Contractor's License Law does not apply to an owner -of property who -
builds or improves thereon and who does such work himself or through 4 his own employees,
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
proving that, he did not build or improve.for the purpose of sale.).,
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
4 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
^ such projects with a contractor(s) licensed pursuant to the Contractor's License -Law.) - -
O 1 am exempt under.Sec. - B. & P.C. for -this reason "
Estimated Valuation
a 120 J"4�
. •
PERMIT - -
"
AMOUNT
Plan .Chk. De p
-
.
Plan Chk. Bal.
395.60
..
COhst- -'
s 50
Mech.
34+00
Electrical -
74.69of
Plumbing
87.0
_
S.M.I. - -
8.30
Grading
CONSTRUCTION LENDING AGENCY
Driveway Enc.
Side'Street Setback from Center Line
Date Owner
Infrastructure
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. - O Certified copy is hereby furnished.
Side Setback from Property Line
Lender's Name
2.891.56
.
TOTAL
• . Lenders Address
CERTIFICATE OF EXEMPTION FROM
REMARKS
-WORKERS'.COMPENSATION INSURANCE
(This section need not be completed if the permit is for one.hundred "dollars ($100) valuation
'
• or less.)
I certify that in the performance of tha work for which this permit is issued, I 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: If, after making this. Certificate of Exemption you should become
ZONE:
BY:
subject" to the' Worker's' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
.Minimum Setback Distances: -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side'Street Setback from Center Line
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.) -
Side Setback from Property Line
Lender's Name
• . Lenders Address
FINAL DATE
INSPECTOR
This is a building'permit when properly filled out, signed and validated, and is subject to '
expiration it work thereunder is suspended for 180 days.
4-21-4S6 '
I certify that I have read this application and state that the above information is correct.
.-Issued by:"
Date Permit
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.},
Validated by:
Signature of applicant ''r f" . r �^ r• Datef
Mailing Address . ' ' _
Validation:
City, State, Zip v
A5320
4 21 289L .5 CK._.
`� HARD COPY
CONSTRUCTION ESTIMATE Allilk
NO. ELECTRICAL FFS911L
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
FINAL INSP.
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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
ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
DUG H PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING d7 C
O
DUCT WORK
ROCK STORAGE
AI FOUND. REINF.
,'i/
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL �0
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
//
A/&RAMING rFINAL
INSP.
%CROOFING .?� c�
0 �d Lt,/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING $ �`
MESH
"INSULATION/SOUND ✓
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
'
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
pq6 ° 'C-(j6,6�(, toa yt,.,l&