002296 (SATT)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-4-09 Cak Hill LA QUINTA, CALIFORNIA 92253
Owner
mise OCEVWW
Mailing
Address "15-005 0=*XV ClUb a—M.
CityZip Tel.
.
Palo
558-2828
Contractor
t
Address ..
City Zip Tela
No. 0022,6
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description pia ywr PLm 2 0
PMW 4 A
State Lic.
& Classic - 2381.31D
City
Lic. # 328
= 2548.
Sq. Ft.GM 424
Size
No.
Stories
No. Dw. j
Units
Arch., Engr.,
Designer
New ®: Add ❑
Alter ❑
Repair ❑ Demolition ❑
Address
Tel.
FINAL DATE
INSPECTOR
Issued by:
Date"`Aermit.
Validated by:
City
'
Zip
State
Lica#
A 5 1 5 3
4 .1U_ 2431,"17 CK
LICENSED CONTRACTOR'S DECLARATION.
Lhereby 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., ( %' • i tr P.%: -, i
- .
.
_
SIGNATUREr V A% i. DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 703.1.5, Business and' Professions Code: Any city or county which requires a
permit to construct,- after, improve ,= demolish, or repair. any structure, prior to its issuance also
requires the applicant for such permit to rile 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 thathe is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant fora permit
' subjects the applicant to a civil penalty of not more than five hundred:dollars ($500): - '"
O 1, 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.)
O 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.)
O.I am exempt under Sec. B. 8 P.C. for this reason
Estimated Valuation
i�
$ 97,623.00
PERMIT -
AMOUNT
Plan Chk. Dep.
- .
Plan Chk. Bal.
3-12
Const.
427.00
Mech. -�yi
AM
Electrical
65.44
-
Plumbing
�; f .5
S.M.I.
_. _
r 83
-
Grading
Driveway Enc.
Date Owner
Infrastructure
1,464.35
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
O_Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
2,437.33.7____
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.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ anyPerson 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
1 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 t /X L-- ---Date _6"'' Z -_t
Mailing Address
City, State, Zip f
f
I HARD COPA
REMARKS
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"`Aermit.
Validated by:
` Validation:
A 5 1 5 3
4 .1U_ 2431,"17 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEE ;I
NO. PLUMBING FEES
IST 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL . HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY'
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. 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
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
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.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
nYarmV1VIS o all m1Vmca/l NeiiNLa,
GARDEN WALL FINAL