002291 (SATT)Building
54_ 4r9 X11
Address
Owner
Rear Setback from Rear Prop. Line
swwim ampany
Mailing
Address
75-005 QMMtLV ClUb I
City
lZip
Contractor
Address .
City
Sam
State Lic.
& Classif: 288130
'Arch., Engr.;
Designer
Address
City
1 hereby
7000) of D
effect.
44
P.O. BOX 1504 No. 00229.
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
We A.P. Number
Tel.
Legal Description
Project Description IM WEST ME 2 M
Tilhaas
Tel.'
City MG 25413
Lic. # 328 Sq. Ft. No. No. Dw.
Size - Stories- Units
New Et Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel.
Zip State
Lic. #
LICENSED,CONTRACTOR'S DECLARATION
that !am licensed under provisions of Chapter 9 (commencing with Section -
3 of the Business�and Professions Code, and my license is in full force and
I
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from' the Contractors License Law for the following
reason: (Sec. 7031:5.Business andProfessions .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 rile a signed statement .thathe is*licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section. 7000) or
Division'3 of the `Business and Piolessions 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 o/'not more than rive 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 improvethereon 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.)
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.)
❑ 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, ora 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.) - - -
I certify that in the performance of the 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.
1 car tify,that 1 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 xauthorize representatives sof this city to enter the above-.
mentioned property for inspection purpose/s. r
Signature of applicant w s> f - -- " —Date—V
Mailing Address
City, State, Zip ' �I
r'
HARD COPY
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Estimated Valuation 37123. 00
PERMIT
AMOUNT
Plan Chk. Dep..
INSPECTOR
Plan Chk. Bal.
352.05
Const.
427 00'
Mech.
34.00
Electrical '6.
AA
Plumbing
83.5
S.M.I.
6.83
Grading
Driveway Enc.
Infrastructure
1,464.35
TOTAL
2,433.17
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:
Date0-8 Permit
Validated by:
Validation:
A51b2
4 lU 2437,.17. CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EESglik
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. 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
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 APPJEQUIP.
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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 APPJEQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
irAbrM, I UK -4 WUNA 1 YN tblINI I IALb.
GARDEN WALL FINAL