001882 (SATT)Building 54-14fl
Address
ftk TIS-_
Owner
'Mailing
Address 75-005 CbMAXY I
City Izip
Contractor
Nat* 1 - Imid 'and P9age
Address
Sam
44
P.O. BOX 1504 No. . 001889,
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number '
Legal.Description
Project. Description PM `Mr VIM .
y... .... .Zipel.
" Cit _
.
Sam.
S€ M
Sam
State Lic.
City
DW 1330 .
& Classif..Lic.
# 328
Sq. Ft. 424 No. No. Dw.
Size Stories Units
Arch.; Engr.; .
' Designer F'A1C ASS='*
�
ISI; Add ❑ Alter ❑ Repair ❑. Demolition ❑
Address
Tel.
2915 Real' 9
(714) 540-511117
City
Zip
State
jl�Mwa
92626
Lic. # .
M _ LICENSED CONTRACTOR'S DECLARATION -
., I hereby affirm_thatI am licensed under provisions of Chapter (commencing wittfSectio
7000) of Division 3 of.the Business and Professions Code, and my license is in Will force and
'BATE
..
% OW ER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
.�'Sr�O
on
reason: (Sec. 7031.5,Suslness 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
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:19 (commencing with Section 7000) of
.�
,ry
'Division 3 of the Business and'Professions Code, -or thdt'he W -exempt therel om,-and the basis
7031.5 'any for 'a
.Plan Chk. De `
p,. -t,
for the alleged exemption. Any violation of Section by applicant permit,
subjects the applicant to a civil penalty of not more than five hundred dollars'($500)."-
-
Plan Chk. Bal. _320.94
❑ 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
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'•througfi his own employees,'-
A `
Mech.- y 34. ��
provided that'. such Improvements are not intended or oNered,for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have: the burden
Electrical
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 to of who builds or. improves- thereon, and who contracts for
-
S. M.I.
apply an owner property
- -such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
ag
Grading
❑ I am exempt under Seca B. & P.C. for. this reason
Driveway Enc. -
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' "Ihereby affirm that I'have'a'certificate of consent to self-ihsure, 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
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
be if the is for hundred
(This section need not completed permit one dollars ($100) 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.
Im Bl= M
' 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
Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
'
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 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 stale 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-.
for inspe/ctio_
mentioned property n'purposes. �,f
_Va4idated by:
//_
'
Signature of applicant .-"Y /• - Date.,/,/
Mailing Address ) f� s
Validation:
City, State, Zip `
A3240 11 13 2a i9,42 Cti_.
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL F8dk
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL. t SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
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.
SQ. FT. ®c
BATH TUB
BOND BEAM .
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE' DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
/ 41 -71R -10 -
r 1 ("'FRAMING 4( 9 R6
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
UND PLUMBINtjJ
i
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
RMS %Z
SEWER OR SEPTI A,//
-j UGH WIRING O
G
v
DUCT WORK
ROCK STORAGE
/ OUND. REINF.Z Q�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
AS (FINAL) A�
r !�
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM .
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
y
414AL INSP.
/ 41 -71R -10 -
r 1 ("'FRAMING 4( 9 R6
FINAL INSP.
iN ROOFING
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING f
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL