002276 (SATT)44a
P.O. BOX 1504 No. 002276
Building 78-105 CALLE ESTADO
Address 54-601 Oak Val LA QUINTA, CALIFORNIA 92253
Owner
smirisn chma riv BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 75-005 CbUntry C17.1b MiVe A.P. Number
CityZip Tel
Alim Desert. -.22.0 1 .828 Legal Description
Contractor Project Description FM WIM PLM 3
matA mu-tXam And LmVit Maw 3A
Address
!s�s�tra
City Zip Tela
State Lic. City DW 16,W
& Classif.. 288130 Lic. # 328 Sq. Ft. MR 424 No -No. Dw. g
Size Stories Units
Arch., Engr.,
Designer New [111$ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel. -
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby.affirm that I,am licensed under: provisions of Chapter 9 (commencirig•with Section
7000) of Division 3 of the Business.and Professions Code, and my license its in full force and
..effect. - �A I/01. y f:
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby,affirm'that I am exempt from�the Contractors License Law for the following�s ���2
reason: (Sec. 7031.5,Business and Professions Code: Any city or county. which requires a '� i
permit fo construct, atter, 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 PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of '
Division 3 of the Business and Professions Code, or Mat. he is exempt therefrom,- and the basis -
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to civil penalty of not more than rive hundred dollars"($500).
❑ ;l, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.' 443.W
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, Mech. �6
provided that Such improvements are not intended or offered. for sale. If, *however, the building •x.00
or improvement is sold within one year of completion, the owner -builder. will have the burden Electrical �
of proving that he did not build orJmprove for the purpose of sale.)
41
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 8y./.58
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law i.�
does not apply to an owner of property who builds or improves thereon; and who contracts for S.M.L..
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .
Grading
0.1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner I f t
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. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
q 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 if 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.,, f /
Signature of applicant i < �'•'�-sem Date -
Mailing Address
City, State, Zip / �r
r'
HARD COPY
n ras ruc ure r
TOTAL 2.558.76
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 4-10-4ermit
Validated by:
Validation:
A5183
4 10. 255&76 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL mift
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
%,SLAB GRADE Q
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
!, / G
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EOUIP.
DRINKING FOUNTAIN
( SO. FT.
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
5 THING 7 69
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
i
D PLUMBING)
UNDERGROUND
A.C. UNIT
COLL. AREA
%,SLAB GRADE Q
PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
fROUGH
OR SEPTIC�AtJOUGH
WIRING, ri/
w
DUCT WORKROCK
STORAGE
FOUND. REINF. G3OUGH)
!, / G
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
�(IBOND BEAM t7
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
PL4ROOFING / /
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
5 THING 7 69
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL
Q-«L.:,Dg,�l WPI 7/aq/t(o