002273 (SATT)Building 54-6,95 1.
Address
Owner
P.O. BOX 1504
78-105 CALLE ESTADO
r LA QUINTA, CALIFORNIA 92253
b-iLnuise M04Mp
Mailing
Address fXY.313]"¢J t
City—
Zip Tel.
DaSp
9M0 .�
Contractor
Address
CityZip Tela
State Lic. City
& Classif. 130 Lic. # 328
Arch., Endr.,
Designer
Address Tel.
BUILDING:TYPE CONST
A..P.. Number
No. 002273
OCC: GRP.
Legal Description
Project Description >�
MR 1330
Sq. Ft. 424 No. No. Dw.
Size- ' Stories' Z' Units
New 0; Add ❑ Alter ❑ Repair ❑ Demolition ❑
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is /or 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 o/ the Labor Code,' you must forthwith
comply with such provisions or this permit shall be deemed revoked. - '
CONSTRUCTION LENDING AGENCY
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.
1 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 sof this city to enter the above-.
mentioned property I6r,inspection purposes. t
Signature of applicant=! { +%�-.:+ . Date !� fir 1rtt
Mailing Address /\ r
City, State, Zip
HARD COPY
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 �Q"3Permit
Validated by:
Validation:
A 5 1 7 8 4 10 2 79,42 CK
City
-
Zip
State
lLic.#
LICENSED CONTRACTOR'S. DECLARATION
heteb 'affirm that I am licensed under provisions of Chapter 9 (commencing with Section-7000)'of DNlsion 3 of•the,Business and.Professions Code, and my license is in full forcexand
effect. - yy t a
SIGNATURE f i DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt fromithe Contractor's License Law for the following
reason:.(Sec.. 7031.5,Business and 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 /or such permit to rile a signed statement that. he is licensed pursuant to
.the provisions of the Contractor's License Law, Chapter9 (commencing with Section .7000). of
Division 3 of the Business and Pro/essions 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 live hundred dollars ($500). '
O 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 /or Sale. 1/, 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.) ' .
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
• such projects with a-contractor(s) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec. B. 8 P.C. for this reason
Estimated Valuation
$ id.7yViD6taVW
PERMIT •.
AMOUNT
• .
.Plan Chk.. Dep.'
'
Plan Chk. Bal.
324 9A
Cbr1St.
�t
Mech.
.';�
Electrical -
ii
59.99
Plumbing
87.50
-
S.M.I.
tf
5.9'9
Grading
Driveway Enc.
1 Date owner
Infrastructure
br276.00
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
O Copy is filed with the city. 0 Certified copy is hereby furnished.
'
TOTAL
2,179.42
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is /or 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 o/ the Labor Code,' you must forthwith
comply with such provisions or this permit shall be deemed revoked. - '
CONSTRUCTION LENDING AGENCY
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.
1 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 sof this city to enter the above-.
mentioned property I6r,inspection purposes. t
Signature of applicant=! { +%�-.:+ . Date !� fir 1rtt
Mailing Address /\ r
City, State, Zip
HARD COPY
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 �Q"3Permit
Validated by:
Validation:
A 5 1 7 8 4 10 2 79,42 CK
CONSTRUCTION ESTIMATE
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
NO. ELECTRICAL EtAlIft
UNITS
MOBILEHOME SVC.
POWER OUTLET
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Di _AS (ROUGH?
i ►�G`AS
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APPJEQUIP.
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
GRADING
cu. yd.
$ plus x$
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
FINAL INSP.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
I.
MICRO FEE
MECH.FEE JPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
I�L SETBACK
ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.?
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEB{I,C N
OUGH WIRING (:
O
DUCT WORK
ROCK STORAGE
FOUND. REINF ns
a�
Di _AS (ROUGH?
i ►�G`AS
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
(FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
.Lie BOND BEAM Z
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING `7
FINAL INSP.
1/ ROOFING ��^' C/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND 7 aI
r. FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
�narc�. � vn a aiunN � uncanm � uaw,
GARDEN WALL FINAL
nuc �e�vQcc i,aLt-/ ��