001866 (SATT)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-156 O&k 'r LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75-05 ODMI--ry ClUb Dave
City Zip Tel.
MM DeSWt 92260 568-2828
Contractor
Hat" Z' l rtigmp
WWI City Zip Tel
State Lic. City
& Classif. Lic. # 32
Arch:,•Engr., '
Designer
^
Address Tel.
CityZip State
m 936 Lic. #
LICENSED CONTRACTOR'S DECLARATION r
1 hereby affirm thaYPam licensed under provisions of Chapter 9 (commencing with'Section
7000) of Divisi`on'3 of the Business and Professions Code, and my license is in full`force and
effect. ,r-
SIGNATURE Z "rDATE
" OWNER -BUILDER DECLARATION' i
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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that.he isdicensed 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 thdrrefiom, 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 of not more than rive hundred dollars ($500): -
0 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 of property who
builds or improves thereon and who hoes 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 Lnprove for the purpose of sale.)-
❑ 1, 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 1 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not -
employ any person in any manner so as to become subject to,the Workers" Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. if, after making this Certificate of Exemption you should become
subject 'to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properlyfilled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above- /
mentioned property for inspection purposes.
Signature of applicant Date ".,7
Mailing Address ` Acs
City, State, Zip d
HARD COPY
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description TIM
OCC. GRP.
WPM TITM '3 0
EW 1627
Sq. Ft.No.
Size Vt
No. Dw.
Stories I Units �
New2p Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
03'Ae 90
PERMIT
AMOUNT
Plan Chk. Dep..�I`
"
Plan Chk. Bal.
364.19
Const.
443.50
Mech.
34.00
Electrical
67.41
Plumbing
87.50
S.M.I.
7.12
Grading
Driveway Enc.
Infrastructure
11,554.38
TOTAL
2,558.76
'4.tlt ;a ti° > �' '• - moi. �� s ? _is
NO i
ZONE: . BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center. Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 11—`S'.$ermit
Validated by:
Validation:
A3269 11 13
255&76 CK
CONSTRUCTION ESTIMATE ,
NO. ELECTRICAL F
NO. PLUMBING FEES
1ST FL. SQ. FT. $ .
UNITS
SLAB GRADE
2ND FL. SQ. FT. ® _
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT.
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. ®
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SQ: FT.
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
I MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
4kAL INSPI
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT ] CFM
IKITCHEN 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.1
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
j
GAS PIPING
PERMIT FEE
PERMFCONJ
PERMITFEE
DBL
TOTAL FEES
MICRO FEE MECH.FEE
PL.CK.FEE
ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK +10
U PLUMBING,
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.77
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 1Cp /� b
a
1 EWER OR SEPTI 47K
1'_AROUGH WIRING
DUCT WORK
ROCK STORAGE
t -j VFOUND. REINF. .L �g
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
,� OAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR. I
4kAL INSPI
ejN FRAMING Cr ®�
FINAL INSP.
ROOFING 3//3
REMARKS:
VENTILATION
FIRE ZONE ROOFING I
FIREPLACE
SPARK ARRESTOR I
GAR. FIREWALL
LATHING } ,
MESH
INSULATION/SOUND
t
FINISH GRADING �.
FINAL INSPECTION
CERT. OCC. f
FENCE FINAL
j
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL