001867 (SATT)4
P.O. BOX 1504 No. 001867
Building 78-105 CALLE ESTADO
Address 542 Omk Trae LA QUINTA, CALIFORNIA 92253
Owner
&=3L�'
Mailing
Address 75-005 0=&—VY C1W1 Dg,
CityZip Tel.
. Palm De,,22� 56&-2-029
Contractor
AaaresS
City Zip Tel.
State Lic. City
& Classif. Lid. # 323
Arch., Engr.,
Designer
un
Address 2915
Sed RM
AV Tel.
*714)
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0-53
City P Zi State
a(1rt4-sa Shur ea to j�'.� Lic. #
LICENSED CONTRACTOR'S DECLAggTION
I hereby affirm that -.I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division3 of the Business and Professions Code, and my license is in full forcela`ndy
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 consliuct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement than 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 eriempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
sub)ects•the-applicant to a civil penalty or not more than live hundred dollars (8500). -
❑ 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 or 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
or 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-
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
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
❑.Copy is filed with the city. O 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 (8100) 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 or 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 1 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 in�spe^'ction purposes.
Signature of applicant ri > r. Date
Mailing Address
City, State, Zip
HARD COPY
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number
Legal Description
Project Description W=x Waco yrzw, -4
Sq. Ft. ,, No. No. Dw.
Size M -424 Stories .1 Units 1
NewO Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT-,
AMOUNT
Plan Chk. Dep. .
Plan Chk.. Bal.
364.19
Const.
443,.50
Mech.
34.00
Electrical
57.41
Plumbing
$7.50
S.M.I.
7.18
Grading
Driveway Enc.
Infrastructure
1,554.90
TOTAL
2,55 .76
REMARKS
LW ET= W=.
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 "Permit
Validated by:
Validation:
A 3 2 6 8 11 13 2558.76 D,
CONSTRUCTION ESTIMATE -
NO. ELECTRICAL EQj,
NO. PLUMBING FEES
1ST FL. SO. FT. ®
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CAR P. SO. FT.
WALL SO. 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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
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.
SO.FT.GAR ® 3/ac
HOUSE SEWER
I?AMING
FINAL INSP.
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
OUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
ORMS a i9
J
S
t 7
I EWER OR SEP �fAI
UGH WIRING %
DUCT WORK
ROCK STORAGE
In FOUND. REINF. � 2
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
�. [�AS (FINAL) I' o
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
ALINSP.
v ,
I?AMING
FINAL INSP.
;'f//ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
,r(.WINSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL