002271 (SATT)Building
Address 54--625 Oat-, Hill
Owner
9=11M calpimy
Mailing
Address 75-005 ClUb
City lz'p-
Ii gz 92260
Contractor
T'Y` t] VnM&MM and T,
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 002271
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
I.
555-28 Legal Description
Project Description PrA WM?�. RJO I CR
I
BY:
Minimum Setback
CityJZip
Tel...
Rear Setback from Rear Prop. Line
State Lic.
& Classif.
City
Lic. # 228
EM 1330
Sq. Ft.
Size 424
No. No. Dw.
Stories Units
Arch., Engr.; '
Designer
New a Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
Validated by:
Validation:
City
Zip
State
4 10 z.I i9.42, CK
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! t I� A: 1 "R' ur/ - DATE
+` !l ''OWNER;BUILDERDECLARATION
I he affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business andf Professions .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 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, dr. 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 penaftyof not more than five hundred dollars ($500).
El 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.) ,
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
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. & P.C. for this reason
Estimated Valuation
PERMIT
-
- AMOUNT -
Plan. Chk:.Dep.
-
Plan Chk. Bal.
y+�/y �g
324.94
COf1St., .
•
1 �j
Mech. -
-
Electrical
Plumbing
87.50struct
_ .
S.M.I.
fj
Grading
Driveway Enc.
Date Owner
Infrastructure
1.276.00
WORKERS' COMPENSATION DECLARATION
Ihereby 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.
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 shouldbecome
subject to the Workers' Compensation provisions of the Labor Code, you must %rthwith
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
I hereby affirm that there i's 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 S t`. j ✓•� ✓1.! /v 1' Date sT h
Mailing Address
City, State, Zip
HARD COPY I
TOTAL 20179.42
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 Permit
Validated by:
Validation:
A 5 1 7 6
4 10 z.I i9.42, CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FE
NO . PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. 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
FLOOR DRAIN
MECHANICAL FEES
STORAGE TANK
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
`
LAUNDRYTRAY
AIR HANDLING UNIT CFM
OTHER APP./EQUIP.
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
WATER SYSTEM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
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 " lQ �
GROUND PLUMBING fU SOL
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
OUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI
; v
�
OUGH WIRING G
O
DUCT WORK
ROCK STORAGE
719 FOUND. REINFC/ 3fig
, GAS (ROUGH)
`
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER'
SERVICE
FINAL INSP.
)LjI� BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
QWK
FINAL INSP.
ROOFING 7
O
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND S
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
MbrrcIUn a WUNAIUneWmIi1Aw.
GARDEN WALL FINAL
RLIL