003145 (SATT)T4*hf 4�Q�w
Building
Address S5-9482 Oak Hill
Owner
Mailing,
Address 75-005 0aumtry Club Drive
City Zip Tel.
Contractor
.Address
Zip - Tel.
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City Zip State
Lic. #
LIQENSED 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.
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
permit. to construct, alter, improve, demolish, or repair any structure, prior'to its issuance also
requires the applicant for such permit to rile 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 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 for a permit
subjects the applicant to a civil penalty ofnot'more than five hundred dollars (8500). ' .
❑ l,'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.) , .
O 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 property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the. Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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.
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. -
N.O. 003345
BUILDING- -TYPE CONST. OCC: GRP:
A.P. Number
Legal Description
Project Description 1 rt 5E: — T11A1!t 100 td
Sq. Ft. DW 3478 No. No. Dw.
Size•Aa $.0d, 'Stories. Units"
New fl Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
_.
$211,438.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. pS!
'Const... 9i g. 6stt
M6ch.
eca ram
Electrical
CONSTRUCTION LENDING AGENCY
Plumbing.
y CA
S.M.I.
Vt;
Grading
V
Driveway Enc.
Side Setback from Property Line
Infrastructure
01110, On
Lender's Address
FINAL DATE
INSPECTOR
This is abuilding permit when properly filled out, signed and validated, and is subject to
'
expiration it work thereunder is suspended for 180 days.
TOTAL
612 t,^r-no) 4% Avg ni
REMARKS.
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 performanceofthe
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 abuilding 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.
'all 'city
Issued by:
Date G In 1r,-? Permit _
I agree to comply With and county ordinances and state laws relating to building
T
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. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. ' SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CARP. SO, FT.
OTHER APP.IEQUIP.
REINF. STEEL
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
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