06159 (SATT)P.O. BOX 1504 No. 46159
Building 55-515 0A Hill7&105 CALLE ESTADO
Address LA QUINTA; CALIFORNIA 92253
Owner
$u10iilae C(3EltaSIIy
BUILDING:TYPE CONST. OCC: GRP.
Mailing
Address 42-600 Co4ek St., Suite 200 A.P. Number, FG& West
CityZip Tel.
Palm Dose ;. . 92260 Legal Description
#.
Contractor Project Description Tract 20717-1 + Medalist
Address
Sam
City Zip Tel.:
State Lic. City
& Classif. 2,88130 Lic. #_ 39JR Sq. Ft. 1288 No. No. Dw.
Arch., Engr.;
Size - - Stories • Units
Designer New ❑ Add -0. Alter ❑ Repair ❑ -Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION.
I herebyy 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
SIGNATURE / /DATE
'r OWNER)BUILDER DECLARATION .
1 hereby affirm that 1 am exempt from the Contractor's License Law for the following Estimated Valuation $96,051
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
Permit to construct, after, improve, demolish. or repair any structure, prior to its issuance also AMOUNT
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 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 vialafron of section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penally of not more than rive hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. S 512..83.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. i�2�J• (��
Professions Code: The Contractor's License Law does not apply to an owner of property who
buikfs or improves thereon arra who does such work himself or through his own employees, Mech. ;3{}• �>�
provided that such improvements are not intended or offered for sale. If, however, the building
orimprovement is sold within one year of completion, the owner -builder will have the burden Electrical R7�
of proving that he did not build or improve for the purpose of sale.) •
44
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing ��{� 5(;
struct the project- (Sec. 7044• Business and Professions Code: The Contractor's License Law .
does not apply to an owner o1 property who builds or improves thereon, and who contracts for S. M.1. 6-.79 "
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure $2,,161.15 1,080.58-.
less Credit 1.080.58
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
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished..
TOTAL M-487.14
CERTIFICATE OF EXEMPTION FROM REMARKS+�en.-:e»c a.��<as:K.'iy•-•t ^.i"x
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the pemmit is for one hundred dollars ($100) valuation +t w'• - ' tDTUWTt._ » - r >1 a
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
aliforniaDateOwner
NOTICE TO APPLICANT: ft, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
cormply with such Provsions or this permit shall be deemed revoked. 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, CW Code.) Side Setback from Property Line
Lenders Name
Lenders Address FINAL DATE INSPECTOR
' 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.. 8111/89
1 certify that I have read this application and state_ that the above information is correct. Issued by: Date Permit
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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
GRADE
UGH' 7I�{
r
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
OR SEPT T OROUGH WIRING,
17
DUCTWORK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
GROUT
WATER HEATER
DRAINAGE PIPING
CAR P. SQ. FT. ®
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
LUMBER GR.
FINAL INSP.
ING /Q q;
FINAL INSP.
URINAL
SQ. FT. @
�
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property lax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L 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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
CERT. OCC.
SQ.FT.GAR ® 314c
HOUSE SEWER
FENCE FINAL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE tL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE
UGH' 7I�{
r
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
OR SEPT T OROUGH WIRING,
17
DUCTWORK
ROCK STORAGE
UND. REINF. %
OUGH)
fA
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
(FINAL)
TEMP. POLE
GROUT
WATER HEATER
VIC
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -plus-x$-=$
LUMBER GR.
FINAL INSP.
ING /Q q;
FINAL INSP.
ROOFING
VENTILATION
�
REMARKS:
FIRE ZONE ROOFING'
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MFJ.SH
NSULATION/SOUND `
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL