002264 (SATT)I W4
P.O. BOX 1504 No. 002264
Building 78-105 CALLE ESTADO
Address 54-941 Oak HM LA QUINTA, CALIFORNIA 92253
— ..._. atm OM*WW
Mailing'
Address 85-005 �" Club Drive
City Zip Tel.
$amt 92260 568.82828
Contractor
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal. Description
Project Description FM mm. A 2 0
PhaW 3A
City.
sam
Zip
Tela
State Lic.
City
Oi+1�'a 2548
& Classif.�
Lic. #
Sq. Ft. 24 No. � No. Dw. �
SizeGAR Stories Units
Arch.; Engr.,
' Designer
New [Jr 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 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
DATE ,
`OWN ER. BU ILIDER-DECLARATION
I hereb affirm that I am exempt from the Contractors License Law for the following
iy affirm p 9
reason. /(Sec. 7031.5,Business and Professions Code: Any, city or county_ which requires a
permit to construct, alter, Improve, and, or repair any structure, prior to its issuance- also
requires the applicant for such permitlo file a signed statement that<hs 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. applicant fora permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). -
❑ I, 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
builds or 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.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-.
Estimated Valuation g�Y�'�3 0�� -
Vk3
-
PERMIT '• AMOUNT
Plan Chk. D.ep.
-
Plan Chk. Bal. 352.05
Const. ' 42740
�it�4 ;y
Meth. - 34.QU
Electrical 65.44
Plumbing 87.50
struct the project. (Seca 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 contractor(s) licensed pursuant to dhe Contractor's License Law.)
❑ I am exempt under Sec. •B. 8 P.C. for this reason
S.M.I. 6.83
Grading
Driveway Enc.
Date owner
Infrastructure 11464.35
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.
_
TOTAL Z;r 43017 %
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 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.
ZONE: - BY:
Minimum Setback Distances:
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
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
A.51b0 4 10 2437,17' Ch
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 iscorrect.•
' I agree to comply with all city and county ordinances and state laws relating to building
construction, and -.hereby authorizeorepresentatives -of this city !o 'enter the above=
mentioned property fo?'inspection purposes.. ,
Signature of applicant 1 a ' C /+fir „ _ Date
Mailing Address =7
City, State, Zip
�{ HARD COPY
CONSTRUCTION ESTIMATE t
NO. ELECTRICAL EESmiih,
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
UGH) �j� .06
r
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
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
FINAL INSP.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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
GRO PLUMBING l `�
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 511111X Rk,
ROU T eUMB. 7 �9�
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
OR SEPT T
14
ROU/ ,RING %
DUCT WORK
ROCK STORAGE
FOUND. REINF.�.,Y �j
a�
UGH) �j� .06
r
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
.g
LUMBER GR.
FINAL INSP.
FRAMING (� 2�
FINAL INSP.
ROOFING
f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
� ANSULATIONISOUND
FINISH GRADING `
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL