002275 (SATT),.s
Building 54-793 M
Address
Owner
Qum&-_
P.O. BOX 1504 No, 002275
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
swwise cmvarxy
Mailing
Address 75-005 n ? tlub Dril'u'1.
City Zip Tel.
palm .. 92260 .. 568-2828
Contractor
Moa
Address
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Legal Description
Project. Description s"'`�1 1 OR
Rhaw 3A
Sam
City
Zip.
Tela
State Lic.
City
DM 1330
& Classif.8$130.
Lic. # 3n
Sq. Ft: No. No. Dw. 1
Size a 4 Stories • Units
Arch., Engr.; .. "- - - .
Designer
New O; Add ❑ Alter ❑' '. Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
• LICENSED CONTRACTOR'S DECLARATION
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
' SIGNATURE• '" �': 1'f :` P"' -s.3'''. ` +'' DATE
ff OWNER -BUIL DER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (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
..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' andiProfessions Code, or'thal.he is exempt therefrom, 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 live hundred dollars ($500).-
❑ I, as owner of the property, or my employees with wages as theirsole compensation, will , .
do the work, and the structure is not intended or offered°for sale. (Seca 7044, Buisness and�COnst.
.. 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,�I
provided that such improvements are not intended. or offered for sale. If, however, the building
or improvement is sold within onyear of completion, the owner -builder will have the burden
of proving that he did not build. or improve for, the purpose of, sale.).
Estimated Valuation �s �ys �yM �A
4e 85#0➢8.00
PERMIT AMOUNT '
--
Plan Chk. Dep. .
Plan. Chk. Bal.' rZ
" ��.
�9 <+ .•
1t rliil�
Mech,. 00
34e
: Electrical' -��'
�j
' Plumbing 87 .50
❑ 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 properly who builds or improves thereon, and who contracts for
suclfprojects with contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
--
S.M.I. '- 5.499
,
Grading
Driveway Enc.
Date Owner
ii��
Infrastructure 1,276.110
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 2.179.42
CERTIFICATE OF EXEMPTION FROM'
WORKERS' COMPENSATION INSURANCE
REMARKS
'
(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.'
ZONE: BY: -
Minimum Setback Distances: '
'
Front Setback from Center Line
•
Rear Setback from Rear Prop." Line
CONSTRUCTION. LEN DING AGENCY
Side Street Setback from -Center Line
I hereby affirrim that there is a construction lending agency for the performance of:the
work for which this permit is issued. (Sec. 3097,.CivilCode.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE INSPECTOR
4
Issued by: Date —1/GPermit
Validated by:
Validation:
A51"&0 4 10 2 I %9,42 R
-
.
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.�
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 ordinarices and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property foNnspectionpurposes` �.."
Signature of applicant ^•f✓2•. rla�"/i- Date
Mailing Address 1'f r1Cl
City, State, Zip K t-
`� /
f HARD COPY
CONSTRUCTION ESTIMATE f
NO. ELECTRICAL FEES' 6 '
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
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
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
S (ROUGH) ?
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
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.
SO. FT. ® c
BATH TUB
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
FIRE ZONE ROOFING
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
SETBACKOUND
PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE S Iy
zGUGH PLUMB. 7�Cj
rop�GH
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR
WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. (?Q�/-f
/
S (ROUGH) ?
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
AS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING ��
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING CJs (j
MESH
VISULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL