002323 (SATT)P.O. BOX 1504 No. 002323
Building 78-105 CALLE ESTADO
Address 54-385 Oak LA QUINTA, CALIFORNIA 92253
swY
BUILDING: TYPE CONST.
OCC: GRP.
Mailing
Address 03IMtXy C,Ub D--.
A.P. _Number
City
ZipTel.
. _
. 92260
568--2828
Legal Description
Project Description
VMn PEM Vii .
ContractorTIM
Hat yhr an id Land
pham 5 A
Address
" City
Zip
Tel. -
State Lic.
& Classif. 288130
City
Lic. # 3.28
UAIG 1918
Sq. Ft.
Size •
No. No. Dw.
Stories Units
Arch., Engr.;,
Designer
New QT Add
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
State
lzip.-
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.
SIGNATURE' _e, - A' 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 to file a signed statement that he is licensed. pursuant, to
Estimated Valuation
7 fV aiS �Ai
PERMIT -
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
3 of e Business and Professions Code, or thathe'is exempt therefrom, and the basis
Division th
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 live hundred dollars ($500).
. 0 I, as owner of the property, or.my employees with wages ah their sole compensation, will
Plan.Chk. Dep..
Plan Chk. Bal.
_ 3 ,
395.60 �
Const.
A
�'v
485��
do the work, and the structure is not intended or offered for'sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to. an owner of ,property who
builds or improves thereon and who. does such work himself or through his own employees,
. provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year or completion, the owner -builder will have the burden'
of proving that he did not build or improve for the purpose of sale.)
0 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044; Business and Professions Code:. The Contractor's License -Law
does not. apply to an owner. of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am.exempt under. Sec. B. & P.C. for this reason
Mech.
34.( T)
ii'
Electrical
7.��
Plumbing
-
87.5
y • S.M.I.
8.34)
Grading
Driveway Enc.
Date owner
Infrastructure
1,805.97
l i$iticatle
n fte 628.00
WORKERS' COMPENSATION DECLARATION
hereby affirm that l 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
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
�C�
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
++'
3. d,19 d6
(This section need not be completed if the permit is for' one hundred dollars ($100) valuation
or less.)
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:
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center. Line
.
Rear Setback from Rear Prop. Line
. 4. CONSTRUCTION LENDING AGENCY- -
Side Street Setback from Center Line '
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.)
Side Setback from Property. Line
Lender's Name
Lender's Address
FINAL.DATE
'Issued by:
Validated by:
Validation:
A 5 3 3 7
INSPECTOR
q+��+t
Date `6 "SVTPermit
4 21 319,.56 CK
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.
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.
.. A 5. .
Signature of applicant Date r
Mailing Address t L4.
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEE`
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®'
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APPJEOUIP.
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.
SO. FT. ® c
BATH TUB
WATER SYSTEM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1114 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
)( ROOFING 71.Y f a
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
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
UGH WIRING$
DUCT WORK
ROCK STORAGE
4e FOUND. REINF. Q
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
t REINF. STEEL? S
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING t,
FINAL INSP.
)( ROOFING 71.Y f a
j< �� 7 6 �Ra/!,-,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
rL,iuM"b wGNA1 VMCb/IIYI I IALb.
GARDEN WALL FINAL
PUC ' 9,/S'8