002312 (SATT)V a 14 14 AOO
ht Q944
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-351 Oak HM LA.QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST.
Mailing
Address 75-005 AXY Club Dmziw
A.P. Number
City Zip Tel.
Palm amwt9226 %8-2828 Legal Description
e
No. ®,023.2
OCC. GRP.
Contractor.
Project Description.
' �
,Address...
sam
Front Setback from Center Line
' City
Sam
Zip
Tel:
Side Setback from Property Line .
State Lic.
& Classif. 288130 -
City
Lic. # 328
W 1548
Sq. Ft.
Size QM 424
No. No. Dw.
Stories. 1 Units
Arch., Engr.,
Designer
New 9S Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
A 5 3 3 9
4 21 3, 65.17 CK
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 o!; he Business and Professions Code,'and my license is in full force and
effect. r .r
.,
SIGNATURE'S - t f' ! c� • _ - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from 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 toIfile 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 703 1. 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.) '
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Coder 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
Estimated Valuation
$ 97s623.00
PERMIT
- AMOUNT
Plan.Chk. Dep.
Plan Chk� Bal..
i,
q •J
33�
COf1St.ifl!
�t5 t
e 00
Mech.
- 34.00
Electrical
e
55.4#
Plumbing
S-M.I-
e`
' .83
6
Grading
Driveway Enc.
Date owner
Infrastructure 10454,35
gee
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
O Copy is filed with the city. ❑ Certified copy is.hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKER'COMPENSATION- INSURANCE
(This section need not be completed it the permit is for onehundred dollars (5100) 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
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:
1 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 ;k •' s •'r . Date J' %
Mailing Address
City, State, Zip
HARD COPYI
•
TOTAL
,REMARKS F5f65•
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-e4erm.it
Validated by:
Validation:
A 5 3 3 9
4 21 3, 65.17 CK
f CONSTRUCTION ESTIMATE AWL
NO. ELECTRICAL FEE2 `
NO. PLUMBING FEES
1ST FL. SQ FT ® $
2ND FL. SO. FT.
POR. SO. FT.
GAR. ' SO. FT. ®
CAR P. SO. 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 FANS EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
IKITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR J HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
1
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/e c
SEWAGE DISPOSAL
I
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE J
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
J
t
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
I
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
aROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
OUGH PLUMB. f
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
egeOUGH WIRING !r C df
0 !J
DUCT WORK
ROCK STORAGE
% _�OUND. REINF. J'
� ,10,170
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
ILS REINF. STEELS
w
GAS (FINAL)
TEMP. POLE
�
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM '
WATER SYSTEM
GRADING
cu.Y d.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
O(?' FRAMING /�,
FINAL INSP.
?Cr—ROOFING /l�i fes/
�l G�G C) �C to � rQq
/—
/
v �X1O
.
-
'
REMARKS:
VENTILATION
1
FIRE ZONE ROOFING
FIREPLACE i
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND ]1
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
1
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
�iG pe�A.�IG' t/ff/ Jr