002315 (SATT)Building
Address
Owner
Mailing
Address
City
PM
Contractor
s
7
r2'
Zip
Idy
44
P.O. BOX 1504 No. 0 0 2 315'
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
City Zip Tela
;
State Lic. City
& Classif. Lic. # 328 .
Arch:., Engr.,
Designer
Address Tel.
City Zip State
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description PGA SWF PLAN 3 CR
Phase 5A-
LTAU 114bz !
Sq. Ft. M 424 No. No. Dw.
Size - - - Stories Units
New C3 Add ❑ Alter ❑ Repair ❑ Demolition ❑
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self•imure, 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS'.COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) 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 the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: It, 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 lendingagency' 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 it 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.
i.�
Signature of applicant _ Date
Mailing Address fi'r'.6 I"
City, State, Zip
HARD COP
n ras ruc ure
TOTAL
AMOUNT
364j.1
44./:
..3w:34 •L
�pS.iY•�U �
REMARKS
Y
Lic. #
LICENSED,CONTRACTOR'S DECLARA—TION
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
BY:
effect. .�.' t' f,
- SIGNATURE I V `•� f. /' .! /s s A' • DATE
-'/ '; 't:01NNER•BUILDERDECLARATION
Estimated ValuationV
I hereby affirm that I am exemptifrom the Contractor's License Law for the following
p�
reason: (Sec.. 7031.5,Business and Professions Code: Any city or county which requires - a
a
- PERMIT.o
permit. to construct, alter, improve, demolish, or repair any structure, priorto its issuance also
file he is'licensed
requires the applicant, for such permit to a signed statement that pursuant to
the provisions of the Contractor's ,L'icense Law, Chapter. 9 (commencing with Section 7000) of.
,plan
Chk. De p
'Division 3 of the Business and Professions Code, or -that. he is- exempt therefrom, and the basis
7031.5" 'any for
for the, alleged exemption. Any violation of Section by applicant a permit
subjects the'applicant to a civil`penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
❑ 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
Const.
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 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 '
. or proving that he did not build or improve for the purpose of sale.) '
O I, as owner of the property, am exclusively contracting *with licensed contractors to con-
Plumbing
• struct the project. (Sec. :7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts for-
S. M. 1.
such projects with a-contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ Lam exempt under Sec. - B. & P.C. for this reason
Driveway Enc.
I f t t
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self•imure, 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS'.COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) 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 the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: It, 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 lendingagency' 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 it 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.
i.�
Signature of applicant _ Date
Mailing Address fi'r'.6 I"
City, State, Zip
HARD COP
n ras ruc ure
TOTAL
AMOUNT
364j.1
44./:
..3w:34 •L
�pS.iY•�U �
REMARKS
Y
ZONE:
BY:
Minimum Setback Distances:
Front Setback 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 Permit
Validated by:
Validation:
A 5 3 2 2
4 21 2558'76 -CK
CONSTRUCTION ESTIMATE I wk
NO. ELECTRICAL FEE
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.,®
POR. SQ. FT. p
GAR. SQ. FT. ®
CARP. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID Q 11/a c
SEWAGE DISPOSAL
Z '\ w jt A p
ll V
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
QCGROUND PLUMBING S 4
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
fMUGH PLUMB. S / Sr
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
OUGH WIRING (J g
DUCT WORK
ROCKSTORAGE
0$FOUND. REINF., O
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
n REINF. STEEL !fir o2
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —plus—x$_=$
LUMBER GR.
FINAL INSP.
AMING
FINAL INSP.
.ROOFING �I r(//
O 5(
Z '\ w jt A p
ll V
< /
O ?�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
''yy
A/, -LATHING
MESH
�4SeNSULATIONISOUND �
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INQrCI —n M J JIUISM 1 YMCW INI I IMLQ.
GARDEN WALL FINAL