002278 (SATT)P.O. BOX 1504 N o , 002278
Building 78-105 CALLE ESTADO
Address 5-709 Mk x.11 LA QUINTA, CALIFORNIA 92253
Owner
Mailing Sww BUILDING: TYPECONST. OCC: GRP.
Address 75-005 CoMtr C•7 » b DriVe A.P. Number
City Zip Tel. --
Palm ..22+ 0 -568-2828 Legal Description
Contractor Project Description TIM ST PAN 3 0
Aaaress
�.
" City
,'
Zip.
Tela
State Lic.
& Classif. 280130
City
Lic. # 328
DM 162
Sq. Ft.
Size 2
No. No. Dw.
Stories Units '
Arch., Engr.; �
Designer
New ®1 Add ❑
-
Alter ❑. Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
"
Lic. #
_ LICENSED CONTRACTOR'S DECLARATION
1 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.• °,-r'.� >�,.:,,✓,f,:' A"/.'.✓. ..{°, f�: .r1"t,P"'
-
..
.. .. -.
..
SIGNATURE. i Z, rf'._ .8 DATE
� DOWNER -BUILDER DECLARATION
I,hereby affirm that I am exempt/from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and;Professions Code: Any city or county.which requires a
permit to construct,. after, fmprove,F,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 Contractors License Law, Chapter 9(commencing with Section 7000) of
Estimated Valuation
103-665.50
T
PERMIT
AMOUNT
-
. ' 'Division 3.of the Business and,Professions Code, or that.he'is exempt thirefrom, 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 rive hundred dollars (5500).
. ❑ 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, Bussness 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.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
strucb the project. (Sec: 7044, Business -and Professions Code: The CoMractor'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 1 am exempt under Sec. B. & P.C. for this reason
plan Chk. De p
'-
Plan Chk. Bal.
-
364-19
Const.
ar-Q
Mech.
5�pp
9a00
3wp
Electrical
�d at
Plumbing
S.M.I.'
__..
Grading
Driveway Enc
Date Owner
Infrastructure
1„554.98
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,. ❑,Certified copy is hereby furnished.
TOTAL
12a558.76
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) 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 10 the'Workers' Compensation
'Laws of California.
-
' Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
BY:
subject' to the Workers' Compensation provisions of -the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
.ZONE:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback.from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.) -
Side Setback from Property Line
Lender's Name
FINAL DATE
Issued by:
Validated by:
Validation:
A 5 1 8 5
INSPECTOR
3
4-1+-86
Date Permit
"
4 10 255876 U
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.
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'heieby authorize representatives -of this city to enter the. above-
mentioned property for inspection purposes. "a
�! f I' ^
Signature of applicant n_✓ �' r s/is. ^. _: Date _ t.+ `F
Mailing Address ! ��! f
City, State, Zip /
r '�
�' HARD COPY
CONSTRUCTION ESTIMATE
1ST FL. SQ. FT. ® $
AD FL. ( SQ, FT.
POR. I SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL f SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
NO. ELECTRICAL EE2111 k
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
I MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL] FLOOR SUSPENDED
I` p4B'`AS (ROUGH a/
LAUNDRY TRAY,
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.
SQ. FT. ® c
BATH TUB
I
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.I
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
7
SQ.FT.GAR ® 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE {
PERMIT FEE
I PERMIT FEE
DBL
TOTAL FEES
j
i
MICRO FEE MECH.FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
!1/6 SETBACKS /O
CC,ROUND PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
C&UGH PLUMB. a,
BONDING
HEATING (ROUGH)
STORAGE TANK
t
FORMS
EWER OR S%CA�4
OUGH WIRIN
DUCT WORK
ROCK STORAGE
FOUND. REINF. i
I` p4B'`AS (ROUGH a/
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL(/ a ?
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
)L�FRAMING d1
FINAL INSP.
ROOFING
J� VENTILATION
REMARKS:
FIRE ZONE ROOFING I
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
t
V� LATHING 2 �.
MESH i
INSULATION/SOUND d
aa..
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
t
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
PC 'Oa.y uvA6l 7/o2`l,,K