002274 (SATT)i
P.O. BOX 1504 No.. 002211 4
Building 78-105 CALLE ESTADO
Address 781 Oa* EIM LA QUINTA, CALIFORNIA 92253
Owner
std CISTMy BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 75-005 CC=tXV Call3b Draw A.P. Number
CityZip Tel.
Fit _ 9fl
5$_2828 Legal Description
Contractor Project Description Im WEST P 1
Address.. .
c�"tt''
City . Zip' Tela
State Lic. City UK 1330
& Classif. 288130 Lic. # 328 Sq. Ft. No. No. Dw.
Size` Stories Units
Arch., Engr.,'
Designer New [X Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address 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 Division"3 of the Business and Professions Code, and my license is iri full force and
effect. : F
SIGNATURE 1 J" 2 i K '" A- DATE _ _ -
(.O*NER•BUILDER DECLARATION
' , Estimated Valuation �'•
I hereby affirm that I am exempt from the Contractors License law for the following
reason: r(Sec. 7031.5,Business and Professions Code: Any city or county which requires a
.permi64o construct, alter, improve, demolish, or repair any.structure, 'pdor to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT _ AMOUNT
the piov,s,Ons 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,rviolation of Section 7031•.5 by 'any applicant for. a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than rive hundred dollars (5500). e�
❑ I, as oner of the property, or my employees with wages as their sole compensation, will Plan ,Chk. Bal. 324.94
do the work, and the structure is not intended or offered for sale: (Sec. 7044, Buisness'and" Const. .6 •�s�
Professions Code: The Contractor's L 34
License Law does. not; apply to an owner of property who . 9g
builds or improves thereon and who does such work himself, or through his own employees, Mech. .2
provided that such improvements are not intended or offered for sale. lf, however, the building
or improvement is sold within one year of completion, the owner -budder will have the' burden Electrical - 519 IN
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- Plumbing87 50
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. .. '52 J 3
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)'
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 3 276.
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'j_
CERTIFICATE OF EXEMPTION FROM REMARKS'.
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for - one hundred dollars (S 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 4o the Workers"Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code,' you must forthwith' Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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
Lender's Address FINAL DATE INSPECTOR
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. Issued by: Date '4M11.5Permit
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 inspection purposesij: /�� Validated by:
Signature of applicant �{ �{ _ r� { i' / 1f!i� ..._. Date % _ //
Mailing Address 1 'f' !w Validation,
City, State, Zip r
i' A51?9 4 10 2.1.79,42 R
` HARD COPY
CONSTRUCTION ESTIMATE
1ST FL. SQ. FT. ® $'
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
NO. ELECTRICAL FEE
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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
/
�(j/ DUCT WORK
(
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OilS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APP.IEOUIP.
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.
SO. FT. ® c
BATH TUB
GRADING
cu. yd.
$ plus x$
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
ROOFING ��%��%f
SO.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
SETBACK
4 &OUND PLUMBIN /v f
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 8�!
H PL'
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SE � ��
GTU7H WIRING
/
�(j/ DUCT WORK
(
ROCK STORAGE
FOUND. REINF. Z ew/
OilS (ROUGH)
METER LOOP y
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING 7 e-,-., /e-4
FINAL INSP.
ROOFING ��%��%f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING (��j�l✓
MESH
�18ULATION/SOUND 7 7 F
gleo
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN FINAL
�W/ALL
P ��%�
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