002319 (SATT)� tl
P.O. BOX 1504
Building
Address 54— � R LA QUINTA, CALIFORNIA 92253
Owner
s
Mailing
Address airlb Drive
CityZip Tel.
. Palm i��xt. 92266 .568-'2828
Contractor
IJat3 M=tqa4and land
Address
City -
State Lic. I City
& Classif. "8130 Lic. # M
Arch., Engr.,
Designer
Address Tel.
City (Zip- (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirrh that 1 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.: ,._
SIGNATURE� 0. DATE
'OWNER -BUILDER DECLARATION
I ,hereby affirm that I am exempt'from the Contraclors License Law for the following
reason: (Sec. 7031.5,Business and -'Professions Code! Any city. or county which requires a
permitto 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.
' 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
subjects the applicant to a civil penalty of not 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 not intended 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 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 .
of proving that he did not build or improve for the purpose of sale.)
0 I, 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 for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
1 am exempt under Sec. B. & P.C. for this reason .
Date Owner
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less:)
1 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: 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 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.
Signature of applicant Date J
Mailing Address
City, State, Zip
HARD COPY
No. 0023.9
BUILDING: TYPE CONST. OCC. GRP.-
A.P. Number
Legal Description
Project Description C
FRM 5 A
ZONE:
BY:
Sq. Ft. Elm 141.627 No.
.Size MR. 424 Stories 1
No. Dw.
Units
New Ek Add ❑ Alter ❑ Repair ❑ Demolition ❑
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Estimated Valuation 1030605.50
Issued by:
PERMIT y
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
364.19
Const. ""
"3.50
Mech.
34.W
Electrical
67.41
Plumbing
87.30
S.M.I.
7.18
Grading
Driveway Enc.
Infrastructure
1,554.98
scbool u n. Bw
TOTAL
REMARKS
3,186.76
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:
A5332
4. 21
31 8676 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EE -21 I lik
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. Ff. ®
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS low
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.
LAUNDRYTRAY
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 ® 11/4 c
SEWAGE DISPOSAL
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
GROUND PLUMBING /I
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
&QUGH PLUMB. fr
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
kROUGH WIRING C_ 0
DUCT WORK
ROCK STORAGE
ZL/ FOUND. REINF. /'1 y
G
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL(v
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
FINAL INSP.
2I -le -FRAMING y / G
FINAL INSP.
vLOf/
xe- ROOFING / i 24
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
Y LATHING $ l�
MESH
i(or—INSULATIONISOUND Q
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
inarrk o vn a 01UNA I uneWrni i Iww,
GARDEN WALL FINAL
,L K_ g`� / (/ Cs �P IJQ / tv to c L