002311 (SATT)414 Qum&.
P.O. BOX 1504 No. 002311
Building 78-105 CALLE ESTADO
Address 54-277 Oak W1 LA QUINTA, CALIFORNIA 92253
Owner
slairise OMX)WW BUILDING: TYPE CONST. OCC: GRP.
a-iThng -
Address 5 oRm+v�.m Drive A.P. Number
City Zip Tel.
Legal Description
Contractor Project DescriptionFIM. 2 OR
U. nutgage and Lmd
Address PhaSa 5 A
S
City Zip Tela '
s
State Lic. City EM 1548
& Classif. 288330 Lic. # 3n Sq. Ft.42 1 No. No. Dw.
Size Stories Units
Arch., Engr.,.
Designer New .[X Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 00) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. 1r ,
SIGNATURE Y' .i- ' .-t ( DATE-
✓ ' OWNER -BUILDER DECLARATION
Estimated Valuation 4
I hereby affirm that I am exempt from the Contractor's. License Law for the following 97,623.00
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 PERMIT 'AMOUNT
the provisions of the Contractor,'s License Law, Chapter 9 (commencing with Section 7000) of
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 five hundred'dollars ($500). -
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 332 .0r
do the work, and the structure is not intended or offered.for sale. (Sec. 7044, Buisness and Const.- �>!�
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 his own employees, ' Mech. .
provided that' such improvements are not intended, or offered for sale. If, however, the building . U - Q
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.) Aq
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing87.50
strucl 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. - A 1
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for thisseason
Driveway Enc.
Date Owner Infrastructure 1._4"J'S
WORKERS' COMPENSATION DECLARATION
Thereby 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 2„427.,17
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 thg 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. ff, 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, CivilCode.)
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 sof this city to enter the above
mentioned property for inspection purposes.
Signature of applicant 5 �= rDate ,�
Mailing Address
City, State, Zip ` t
HARD COPY
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 4"21'^ Permit
Validated by:
Validation:
A 5325
4 21.
2437.'17 Ck
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EEU11k
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
Gf10UGH PLUMB. jr
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING /
FINAL INSP.
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
0.0 ROUND PLUMBING;
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
Gf10UGH PLUMB. jr
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
fgeOUGH
WIRING
DUCT WORK
ROCK STORAGE
QI,e.'FOUND. REINF. 0
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL 7 1
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING /
FINAL INSP.
&,eROOFING `?� �j/ Z
J O
/-Tp w e✓�
!
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
N,66LATHING 16
MESH
GLINSULATIONISOUND Q
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
f -UL 61 f 6 r S- Q O L wv:%lC.-