003194 (SATT)Building
Address 5&-94q natt rdq .7
Owner
44
P.O. BOX 1504 No. 0 t 319 4
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address 75-005 Country Club Drive
City€9alm Desert Zip 92260 Tel. 568--2828
Contractor
ress
State Lic.
& Classif. 2.88130
Arch:; Engr.,
Designer
Address
Tel.
City
Lic. # 37A
Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
BUILDING: TYPE CONST. OCC: GRP.
A.P. NumbertnA w?mt
Legal.Description
Project Description ftswo 10—A_ 'PI nn; -WA
Sq. Ft. G .1627
Size M - 424
New ❑ Add ❑
1 hereby affirm that 1 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
rr j
SIGNATURE DATE
"' " • - OWNER -BUILDER DECLARATION'
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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
PERMIT .
the provisions of the Contractor's License Law, Chapter 9- (commencing with Sectionr 7000) of
Division 3 of the Business and Professions Code, or that: he is exempt therefrom, and ' the basis
Plan
for the alleged exemption. Any violation of Section 7031.5. by 'any applicant- for a permit.
Chk. Dep..
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan. Chk. Bal..,
❑ 1, 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, Bussness 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,
Mech.
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.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
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 a contractors) licensed pursuant to -the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner I I
WORKERS' COMPENSATION DECLARATION
'I hereby affirm that I'have'a certificate of consent to self -insure, ora 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
—' Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor *Code, you "must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)'
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated; and'is subject to
expiration if work thereunder is suspended for 180 days. '
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter' the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
Structure
TOTAL
No. No. Dw.
Stories Units
Alter ❑• Repair ❑ Demolition ❑
t _ 797 M�
AMOUNT
380.44
46}�8.0
34 '
s 00
67.51
87.50 .
7.95
' t 919t.C. At
HtMAHKS
i0_ CASH t TW AL 1 275 1, '.1
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 61241-A7 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1$T FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SO. 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
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
v ,
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
INSP.
ROOFING Gy
[[
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
v ,
GAS (ROUGH) �u 6
# dAETER LOOP
//TEMP.
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. // G�
FRAMING B7 1OFINAL
INSP.
ROOFING Gy
[[
7
d
v
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL