001890 (SATT)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address SA—MA 01ak WaP LA QUINTA, CALIFORNIA 92253
Sa'3'2XILW
Mailing
Address 75--005 Qmuttry (nib
City Zip Tel.
aba � 92260 568-2828
Contractor
. V 1 Liarl and Norbsaoin
Address.'.
City Izip Tela
State Lia City
& Classif. Lic. # 320
Arch., Engr:,
Designer Fk3bert AlteVe= ASS=.
Address Tel.
2915 Had RM Ave. MQ 540-5117
City Zip State
92162A Lic. #
LICENSED CONTRACTOR'S DECLARATION" _
I hereby affirrti,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 ands.
effect! /
DATE
/ OWNER�BUILDER DECLARATION
(.hereby affirm that I am exempt from the Contractor's License Law for the following
reason 1 (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 of not more than five hundred dollars (8500):
O 1, 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.) - -
❑ 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
v* ,
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. ❑ 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 mannerso 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
1 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 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. r _
Signature of applicant '� ^� 1 _� Date,/!
Mailing Address
City, State, Zip
HARD COPY
No. 001890
(BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
,Legal Description
Project Description VM WMT FILM 2M
EM 1548.
Sq. Ft. No. No. Dw.
Size 424 Stories 1. Units 1
New,R Add ❑ Alter ❑ Repair ❑
Demolition ❑
y
Estimated Valuation S 97,523.00
PERMIT
AMOUNT
Plan.Chk. Defi.�,+1'\v
'2
Plan Chk. Bal.
351.1015
Const.
427.00
Mech.
34.00
Electrical
65.44
Plumbing
87.50
S.M.I.
6•83
Grading
Driveway Enc.
Infrastructure
lo464.35
TOTAL
2,437.17
REMARKS
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:
A3202 11 13 241k7.17 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FE
NO. PLUMBING FEES
IST FL. SQ. FT. @
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. 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
I If
FLOOR DRAIN
MECHANICAL FEES
STORAGE TANK
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
ROCKSTORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APP./EQUIP.
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
WATER SYSTEM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
RbUND PLUMBING'
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
I If
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS Z / $� '
' �EWER OR SE
C T N—
OUGH WIRING y/' vv
DUCT WORK
ROCKSTORAGE
+OUND. REINF. I Z �6 /
S
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
/� i!�
Y/
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
��j
tf INAL INSP.7G°J
*FRAMING ( ®�
FINAL INSP.
(� ROOFING If
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
+�. LATHING
MESH
w-#INSULATIONISOUND 1A140
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
IIVJYC%'1 UM"J JIUNA 1 UMrWINI I IALJ.
GARDEN WALL FINAL