002280 (SATT)Building
54-'769 O&k HM
Address
for the alleged exemption. Any , violation of Section 703 1. 5 by 'any applicant for. a permit
Owner
subjects the applicant to a civil penalty of,not more than'tive hundreddollars ($500).
Plan Chk. Bal.
SA'tZ„: im iirF7
Mailing
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Address
75-00-5 CoMtrY C.b DziVe
CityZip
builds or improvesthereon and who does such work himself or through his own employees,
Mech. .
Tel.
Validated by:
92260 -
Electrical
Contractor
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to corn.
"At -1- w3ftimme and, ZIP -410
Address
Zip
State Lic. .1city
& Classif. 288130 Lic. #
Arch., Engr.,
Designer
Address Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 002280
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
568--2828 Legal Description
Project Description IS IM VWT PIM 3 0
MC 1627
Sq. Ft. 424 No. No. Dw.
Size Stories Units
New [ij Add ❑ Alter ❑ Repair ❑ Demolition ❑
City Zip State
_ Lic..#
LICENSED CONTRACTOR'S DECLARATION
1-herebyy affirm that I.am licensed under provisions of Chapter 9 (commencing with Section
7000).oflblv,isionr3 otthe Business and Professions Code, and my license is in full force and�+
effect.N �./ .irV;4, . f yrs
SIGNATURE Ai r ! 7I,'- 'DATE
i !'L/OWNER-'BUILDER DECLARATION
I h�eby affirm that I am exempt from the Contractors License Law for the following Estima
reasori: (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
r
requires the applicant for such permit to role a signed statement that he is licensed pursuant to
the provisions or 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
PERMIT.
Minimum Setback Distances:
for the alleged exemption. Any , violation of Section 703 1. 5 by 'any applicant for. a permit
Plan Chk. Dep.
subjects the applicant to a civil penalty of,not more than'tive hundreddollars ($500).
Plan Chk. Bal.
❑ I, as owner of the property, or my employees with wages as their'sole compensation, will
Side Street Setback from Center -Line
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
ConSt,.
Professions Code: The Contractor's License Law does not apply to an owner of property who .
FINAL DATE
builds or improvesthereon and who does such work himself or through his own employees,
Mech. .
provided that such _improvements are not intended or offered for sale. If, however, the building
Validated by:
or improvement is sold within one year or completion, the owner -builder will have the burden-
Electrical
of proving that he did not build or improve for the purpose of sale.) ,
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to corn.
Plumbing
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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. 8. & P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure
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 if the permit is for 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 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 authorizedrepresentatives -of this city to enter the above-
mentioned property for ffispection purposes./
Signaturo'ofapplicant X. I/K11i',�io.11. -" Date F
Mailing Address ✓ . 4
City, State, Zip
r
fY
HARD COPY
TOTAL
REMARKS.
665.50
AMOUNT
364.19
443.50
34.00
67.41.
87. p50
0.18
1.,554.98
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 b� Permit
Validated by:
Validation:
A5187
4 10 2558.76 U
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEE `
NO. PLUMBING FEES
IST FL. SQ. FT. a $
2ND FL. SQ. FT.
POR. SQ. FT; ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SO. 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
FORMSD
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GA G )%�
(
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. 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
SETBACKGROUND
PLUM I(eG
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROU . '! `�rj�e
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSD
WER OR SE
R WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. L�Z El!'
GA G )%�
(
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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.
FRAMING �fQ �ry �i
FINAL INSP.
ROOFING 7/(iC��GIi�—
VENTILATION �l STB
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
�6—SU LATIONISOUND-7
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL