002266 (SATT)Building
Address
State
54-661. Oak IRM .
Owner
the provisions of the Contractor'sfLicense Law, Chapter 9 .(commencing with Section 7000) of
,
Mailing
Plan. Chk. Dep..
Address
75-005 OmmtrY Club Drive
City
395,60
ZipTel.
Palsm De
92260
Const.
Contractor
Professions Code: The Contractor's License Law does not apply to an owner of property who
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Address
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City
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Zip
Tel.-
el'
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
I
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
568-2823
City
Lic. #328
Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION_.
I hereby affirm that,l'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
ii OWNER:BUILDER DECLARATION
I her
that I am exempt from the Contractor's License Law for the following
reason:!(Se,. 7031.5,Business and,rProfessions Code: Any city or county which requires a
No. X 02266
BUILDING: TYPE CONST. .00C: GRP:
A.P: Number
,Legal Description
Project Description V�. RM -1 4 0
Pbalse 3A
Sq. Ft. No. No. Dw.
Size MR 424 Stories' � Units �
-New I& Add ❑ Alter ❑' Repair ❑ Demolition El
Estimated Valuation $ 103,r665e50 .
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 that he is licensod pursuant to
- PERMIT
AMOUNT
the provisions of the Contractor'sfLicense Law, Chapter 9 .(commencing with Section 7000) of
,
Division 3 of the Business and Professiohs Code, or. that. he is exempt therefrom, and the: basis
Any Section 7031.5 any for
Plan. Chk. Dep..
for the alleged exemption. violation of by applicant a permit
subjects the applicant to a clviipenalty of not more thanrive hundred dollars ($500). -
Plan Chk. Bal.
395,60
❑ 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
Const.
4�
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,
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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
Electrical
a
�[?t��j
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-
Plumbing
87.50
• 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.,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner.
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hefeby 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. ❑ Certified copy is hereby furnished.
TOTAL
2.891.56
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) 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 of Exemption you should become
ZONE:
BY:
"subject" to the Workers' Compensation provisions of the Labor Code, you must forthwith
Setback
Distances:
comply with such provisions or this permit shall be deemed revoked.
,Minimum
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
1 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
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to '
if thereunder is for 180 days.
�� Ly
4-10-86
expiration work suspended
I certify that I have read this application and state that the above information is'correct.
Issued' by:
Date Permit
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.
Validated by:
�. 'r'' "'�
Signature of applicant - • �� _ Date_
Mailing Address / �_ f- •' ' f'
Validation:
City, State, Zip '
A5169
4 10 289156 CK
HARD COPY
CONSTRUCTION ESTIMATE ' ''
NO. ELECTRICAL EGAM
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS low
COLL. AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
EWER OR SEPTI K
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DRAINAGE PIPING
WALL SQ. FT.
HEATING (FINAL)
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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.
SQ. FT. ® c
BATH TUB
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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
ZLI(SETBACK V
GROUND PLUMBIN ��j�j
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. 7
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPTI K
uROUGH WIRING
el
CCMETER
DUCT WORK
ROCKSTORAGE
K. FOUND. REINF.%
S (ROUGH) �ra
LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
14COND BEAM `7 _21
k
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 S�
MESH
1 INSULATIONISOUND?
1
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL