002288 (SATT)Building - 54-517 03k EM
Address
Owner
Mailing
Address 75 -
City
Palm Dc -
Contractor
Address.
Sam
Zip
Zip
4
P.O. BOX 1504 No.
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Drive
Tel.
568-2V28
BUILDING: TYPE CONST. ,:_OCC: GRP.-
A.P. Number
Legal Description
Project Description W-st. PI -3 1 Q
PhaW 4 A
State Lic.ty
1330
& Classif. 288130
Tic. # 320
Sq. Ft. mR .424 No. 1 No. Dw.
Size -Stories - Units
-Arch., Engr.,
Designer
New OX Add El
Alter 0 Repair 0 Demolition 0.
Address
Tel.
City
Zip
State
FZ
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that larn licensed under provisions of Chapter 9 (commencing with Section
7000) of'Diviiion 3 of.the Business,and Professions Code, and my license is in full force and
effect. . X -
SIGNATURE DATE
OWNER -BUILDER DECLARATION
'hereby affirm that I am exempt fromthe Contractor's License Law for the following
Estimated Valuation
85'romAo
reason: (Sec. '703 1. 5, Business and Prof6ssions Code: Any city or county Which requires a
permit to construct, alter, improve, dent6lish, loi. -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).
0.1 as owner of. the.prpperty, or my employees with wages as their sole.compensation, will
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
324.94
Const..
391.00
do ihe 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
Mech.
34.00
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
Electrical
51-4.99
or improvement is sold within one year of completion, the owner -builder r will have the burden
of proving that he did not build or improve for the purpose of sale.)
Plumbing
0 1, 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
• S.M.I.
SAN
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
Grading
Driveway Enc.
Date Owner
Infrastructure
1.276.00
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
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
REMARKS
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 thp 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
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
—Front.
Setback from Center Line
Rear Setback from Rear Prop. Line
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
FINAL DATE
INSPECTOR
—
410-ffpermit
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'inspection1purposes r
Signature of applicant Date—
Mailing Address
Issued by:
Validated by:
Validation:
A,5 1 Y 5
Date
4 1-0 2 9. 4 2 CK
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE AN
NO. ELECTRICAL FFSdMb,
NO. PLUMBING FEES
IST FL. t SQ. FT. ® $
.2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. 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 I
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.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. i 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
1
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. 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 1 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE I
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS I
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL i
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAMi
WATER SYSTEM
GRADING
cu. yd.
$ -plus-x$_=$
I
LUMBER GR. 1
FINAL INSP.
FRAMING I
FINAL INSP.
ROOFING l
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE }
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING 1
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
IIVAMI, 1VKJ W UNA I UnrWINI I IALJ,
GARDEN WALL FINAL