003191 (SATT)bf 4 4 . Qu wo a
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-9815 Oak MUI LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address .76—(*5 Cam$ry Club Drive.
City Zip Tel..
iF 1 Desert.
02260 566-282.8
Contractor
Nates Mortgage & Lemd
-Address
Sam
Zip -Tel.
State Lic.
& Classif.
Arch:, Engr.;
Designer
Address
I Lic. # 318
Tel.
CityZip I 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 In full force and
effect. s.-, Y_ i —77
SIGNATURE DATE
OWNER -BUILDER DECLARATION '
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
No. 003191
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PQ West
Legal Description
Project Description Pbase 30°A, p 3
MG 2527
Sq. Ft. No. No. Dw.
Size M 4-24 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
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
PERMIT
- -
AMOUNT
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'isexempt therefrom, and the basis -
for Any Section 7031.5 'any for
Plan Chk. Dep:
the alleged exemption. violation of by applicant a permit
subjects the applicant to a'civil penalty of not more than five hundred dollars ($500).
Plan. Chk. Bal.
_ 380.44
��
0 I,,as owner of the property, or my employees, with wages as their sole compensation, will
ey a
do the work, and the structure is not intended on•offered for sale. (Sec: 7044, Buisness and
Const.'
Professions Code: The Contractor's License Law does not apply to. an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
Mech.
14.00
- provided that' such improvements are not intended or offered for sale. If, .however„ the building
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
X97.5$
of proving that he did not build or improve for the purpose of sale.) . .
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
87.50
,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.
_
7..95
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
- -
O 1 am exempt under Sec. - B. & P.C. for this reason
Driveway Enc.
Dateowner
Infrastructure
WORKERS' COMPENSATION DECLARATION
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,�§ta2�
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be if the is for hundred dollars
jZ•y;g- w'�^���i7r, i'`
completed permit one ($100) valuatione'i-'�(w
or less.).
�•aj^; ,; •-;q
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
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Setback
Distances:
comply with such provisions or this permit shall be deemed revoked. '
.Minimum
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 buildingpermit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
612€ /87 Permit
I certify that I have read this application and state that the above information is correct.
'
Issued by:
Date
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. 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
GAS (ROUGH) /J ,
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.
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE UPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE---] PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING a
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SE ICT NK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) /J ,
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) f� ��
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING �O'Q
FINAL INSP.
ROOFING q '6g/7 f�
�j
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 2 Q
MESH
INSULATION/SOUND Z
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL