002262 (SATT)P.O. BOX 1504 N o'. 002269
Building 78-105 CALLE ESTADO
Address +�d..�?1 f3�t 335��?l. LA QUINTA, CALIFORNIA 92253
CbMpMy
Mailing
Address 7r5„ 005 Qwrfty Ctub' Dr.
City Zip Tel.
�n49r . t1�a.eco . A??t - rAQ_7 7R
Contractor
HatI
Address
City jZip jTel."
State Lic. ICity
& Classif:Lic#
. 2ARIM . 328
Arch., -Engr.,
Designer
Address Tel.
City Zip State
Lic. #
-LICENSED CONTRACTOR'S DECLARATION
I here
byyffi
arm 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 .
ndeffect. A e
SIGNATURE�N ` /' .r,DATE
L'6WNER78UILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following . .
reason:,'(Sec. 7031.5,Business ands' Professions Code: Any city or county , which requires a.
permVto 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 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, or that. he 'is exempt therefrom, andthe basis
for -the alleged exemption. "Anyviolation of Section 7031.5 - by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
p 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 .
buildsor 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.) -
O I, 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ l am exempt under Sec. B. & P.C. for this reason
Date Owner
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.
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 lhp 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 of the Labor Code, you must forthwith .
comply with such provisions or this permit shall be deemed revoked.
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number
Legal Description
Project Description FM T FLM. 2 7
Maw- 3 A
VW 2548
Sq. Ft. C 424 No.
Size Stories
No. Dw.
Units
New Dt - Add O Alter ❑. Repair ❑ Demolition O
CONSTRUCTION LENDING AGENCY
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 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 insl!pection purposes. T
1 =',f--. llr'r � Daley a 1 -
Signature of applicant `-`'r
Mailing Address
City, State, Zip 1 f
�/ . HARD COPY
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
-
Plan Chk. Bal..
2-352.05
Corist..-j
s(t?
Mech.
4-00
.Electrical',��
4 10 2437,17 CC.
Plumbing�a�
S.M.I..P
Grading
Driveway Enc.
Infrastructure
1.464.35
TOTAL
s;Ts 1 ..17
REMARKS
CONSTRUCTION LENDING AGENCY
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 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 insl!pection purposes. T
1 =',f--. llr'r � Daley a 1 -
Signature of applicant `-`'r
Mailing Address
City, State, Zip 1 f
�/ . HARD COPY
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:
DatePermit
Validated by:
Validation:
A 5 1 5 8
4 10 2437,17 CC.
CONSTRUCTION ESTIMATE All&
NO. ELECTRICAL FEE
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. I 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
S (ROUGH) 7
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.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
?C,,/ SETBACK �V
GROUND PLUMBING; o
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
,ROUGH PLUMB. -7 J
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
DIZEWER OR SEPTIIC&O
4
WIRING �%O
/METER
DUCT WORK
ROCK STORAGE
l'OUNUGH
I FD. REINF. L/ '1 3
o�
S (ROUGH) 7
LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS( INAL)
TEMP. POLE
GROUT '
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
ZQ&RAMING /
FINAL INSP.
ROOFING 7 /� g -re
l i d
REMARKS:
j�
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�.Q LATHING Q
MESH
!1 INSULATION/SOUND .7 alp
I"
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
UM'D WUNA1 UHLblI VI IIALJ
GARDEN WALL FINAL
tgq,c O Ky wa61L 7?vZ`l/ b-�; .