002270 (SATT)4. 44, 0
P.O. BOX 1504 No. 002270
Building 78-105 CALLE ESTADO
Address MUM 54--613 (a, HM LA QUINTA, CALIFORNIA 92253
'
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description
OCC: GRP. '
PM VWT -UM .I
fi 3' A
Mailing
Address 75"05 �" y � Drove
City JZip Tel.
. Palm � 92260 1568_2S28
Contractor.
�'1 114es�i*>cJal at .tiTT„�
Address
same
Infrastructure
Side Street Setback from Center tine
City
Zip
Tel.'
INSPECTOR
Issued by:
State Lic.
& Classif. 288130
City
Lic. # 328
MM 1330
Sq. Ft.(MR 424No.
Size •
No. Dw.
Stories ` Units
Arch., Engr., - • - -
Designer
New IM. Add ❑
Alter 0 Repair ❑ Demolition ❑
Address
Tel.
�i%9,42 C6
'
City
_
Zip
State
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 I' F ! DATE
OWNER
•BUILDER DECLARATION I
I hereby affirm that I am exempt/from the Contractor's License Law for the following
reason: `(Sec. 7031,5, Business and Professions Code: Anycity orcounty which requires a
permit to construct, atter, Improve, demolish, or repair any stnicture, prior to its issuance also
requires the appllcant for such permh to rile a signed statement that he is ficensod pursuant to
the provisions of the Contractor's.Ocense Law, Chapter 9 (commencing with Section 7000) of
' 4Division 3 bf the Business and' Professions Code, of that. he isexempt therefrom; and the' basis
for the, alleged exemption. Any violation of Section 7031.5 by -any appi�ant for- a permit
' subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
❑ 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 appy to an owner of property who
builds cr improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for safe. If, however, the building
Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal..
or improvement is sold within one year of completion, the owner-bra7der wi0 have the burden
of proving that he did not build or improve for the purpose of safe.) -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
slruct 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.) - -
- ❑ I am exempt under. Sec. B. 8 P.C. for this reason
EIBCtrIC1I
Plumbing
S. M. 1. .
Grading
Driveway Enc.
Date Owner
Infrastructure
Side Street Setback from Center tine
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
❑ Copy is filed with the.city. O Certified copy is hereby furnished.
Side Setback from Property Line
TOTAL
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 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 or 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
REMARKS
8510NA0
AMOUNT
,r'2 s94
391.00
�49
5,99
1.,276.00
ZONE:
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%nspection purposes.
Signature of applicant = \ % f /' fr r _ Date �/ �/ i
y < �~
MAddress
Mailing
City, State, Zip
rY
r/
HARD COPY
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center tine
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 4—M-2ermit
Validated by:
Validation:
A5175
4 1.U.
�i%9,42 C6
'
CONSTRUCTION ESTIMATE
NO. ELECTRICAL qdk,
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
2ND FL. SO. FT. @
POR. SO. FT. @
GAR. SO. FT. @
CAR P. I 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
eq -GAS (ROUGH)? / c
!J
`GAS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EOUIP.
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 @ 1114 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
NSETBACKROUND
u
PLUMBING��U�
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
,ROUGH PLUMB.' /
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEP1jrN -
/�,tROUGH WIRING C
d
v�JMETER
DUCT WORK
ROCK STORAGE
FOUND. REINF. L
II
eq -GAS (ROUGH)? / c
!J
`GAS
LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
REINF. STEEL
(FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
2V—BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_ $
LUMBER GR.
FINAL INSP.
eLCRAMING S
FINAL INSP.
?4e
?4 ✓ROOFING j /
VENTILATION �o
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 2 �(p
MESH
l INSULATION/SOUND
1
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
RUC- ba -'t K.) a L '1/a2L1 ��