002263 (SATT)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address S4 -'?33 Oak RM, LA QUINTA, CALIFORNIA 92253
MVIXIAM OMqXMY
Mailing
Address 75-005 Pit -MILKY C
City lZip.
P.4a92
Contractor
ress
City , sil IZip
State Lic.
& Classif.
Arch., Engr:, "
Designer
Address
Tel.
Tela
City
Lic. #
Tel.
City Zip State
. Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter'9 (commencing with Section
7000)of Division3 of the Business and Professions Code, and my license is in full force and
effect. d: .6 Vl %f
SIGNATURE : A ,WT7, 7 r 7. i !.:%+%t'? .k_J, DATE
21 ,` - 'i -!OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's. License. Law for the following
reason:' ($a&-,7031.5,Business and Professions Code: Any. city or county which requires a
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description
No. 002263
OCC'. -GRP.
PMTS. MMa1
Phase 3A
Sq. Ft. 2548 No.
Size 4P4 Stories
No. Dw.
Units
New Oma,- Add ❑ Alter ❑ Repair ❑ Demolition ❑
Permit, to construct, after, 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, or' that. he is exempt therefrom' and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any .applfcant for a permit
' PERMIT .� .
'
Plan Chk. Dep.
- subjects the applicant to a civil penalty of not more than five hundred'dollars (5500). '- -
❑ I, as owner of the, property,. or my employees with wages, as their sole compensation, will
Plan Chk. Bal.
Const.
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 ofproperty who
Mech. '
' builds or improves thereon and who does such work himself orthrough his own employees,.
provided that' such improvements are not intended or offered for sale. If, however, the building
Electrical '
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.)
Plumbing
❑ 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
S. M. I..
• 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
Grading
Driveway Enc.
f t
.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
O Copy is filed with the city. ❑ Certified copy is.hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 the permit is for one hundred dollars ($100) 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
subject to the Workers' Compensation provisions of the' Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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 if 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 forinspection purposes.
Signature'ofapplicant r 5� .�� �-J Date ✓fr'-ls!
Mailing Address
City, State, Zip
f� HARD COPY
In rastruc we
TOTAL
REMARKS
623.00 -
AMOUNT
352.05
427.00
34.00
65.44
M50
6,.83
1,4U.35
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 4"10—$6Permit
Validated by:
Validation:
A5159
4 10 2431.17 U
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EESdilk .
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT. ®.
POR. SO. FT. ®
GAR. SO, FT, ®
CARP. 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
f(,/<SETBACK/� U
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SLAB GRADE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
BONDING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
T FORMS vl it
J
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
GAS (FINAL)
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
WATER HEATER
SQ.FT.GAR ® V4c
HOUSE SEWER
BOND BEAM
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
f(,/<SETBACK/� U
ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
&&OUGH PLUMB. IF,
BONDING
HEATING (ROUGH)
STORAGE TANK
T FORMS vl it
J
OSEWER OR SEPT
UGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
n1KS (ROUGH)
`•c
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
AIK FRAMING 7
FINAL INSP.
ROOFING L`
L
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
0
MESH
INSULATION/SOUND �! C
J G
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
'
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL