001864 (SATT)Building
Address
54-2M (�� .
Owner
. 2915 Rad RM
4710 540-5217
Mailing
CityJZip
Address
75 Cknultry club
CityZip
-
ex 9220 -
Contractor
LICENSED CONTRACTOR'S DECLARATION _
MVI laand and Mott(
Address
State Lic.
& Classif.
Arch., Engr.,
Designer
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No.
001864
BUILDING: TYPE CONST. OCC: GRP.
C. A.P. Number
Tel.
�. Legal Description
Project Description PM MW MAN 8
Sam
City yrs lbzl '
Lic. # 328 Sq. Ft. 424 No. I No. Dw.
Size Stories Units
�� New Add ❑ Alter ❑ Repair ❑ '. Demolition ❑
Address
Tel.
. 2915 Rad RM
4710 540-5217
CityJZip
State
92r026
Lic. #
LICENSED CONTRACTOR'S DECLARATION _
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing'witfi Section
7000) of Division3 of the Business add Professions Code, and my license is in full force and
effect..
. SIGNATURE 1 - / DATE
.. . , .
OWNER -BUILDER DECLARATION f
I hereby affirm that I am exempt from the Contractor's License Law for the following
..
�p�
Estimated Valuation �' 103j665eS4V
reason: (Sec. 7031.5,Businessoand Professions Code: Any city or county which requires a '
'after,
. permit to construct, improve, demolish, or repair;any structure, prior to its issuance also
requires the applicant for such p�mdt to rde a signed statement that he is .licensed pursuant to
- - -
.. PERMIT • AMOUNT '
the provisionsof the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
�c
' Division '3 of the Business and Professions Code, or that. he is exempt therefrom,' and the basis
'any
b'� ` - -- s • .
'Plan Cihk. Dep.
for the affeged exemption. Any violation of Section 7031.5. by applicant for a permit
' subjects the applicant to a civil penalty of not more than five hundred dollars (S500)-,*
*will
'
�q
Plan Chk. Bal. 364.19
❑ I, as owner of the property, or my, employees with wages as their sole compensation,
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 inproves thereon and who does such work *himself or through hisownemployees,.
egg
-Mach. 1.1V
3.Y.
. provided that such improvements are not intended oroffered for sale. If, however,,.the building,
or improvement is sold within one year of completion, the owner -builder will have the burden
wq^
Electrical - 67.41
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 87.50
struct-the. project. (Sec: 7044, Business and Professions Code: 'The Contractor's License Law
does not to owner of who builds or improves thereon, and who contracts for
q�9
- S.M.I. 7.18 "
apply an property
-such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
O 1 am exempt. under Sec. B: & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure 1,554.96
WORKERS' COMPENSATION DECLARATION
• A 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
O Copy is filed with, the city. . ❑ Certified copy is hereby furnished.
TOTAL 26558.76
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($ 100) valuation
,
a��±a�
MT fi�L�,7 SPA Amy MW OF ms PMMTo
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 Lsubject to the Workers' Compensation
Laws of California.
' Date Owner
NOTICE TO APPLICANT. N, after making this Certificate of Exemption you' should become
ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minima m 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, 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.
y y1o p—U� -
1
I certity•that I have read this application and state that the above information is correct.
'all
Issued by: Date 13-8 Permit
Pagree to comply with' city and county ordinances•and state laws relating to building
construction, and hereby authorize, representativesi-of this. city to enter the above-.
' mentioned property for inspection purposes.'
,.=• "
s- ,rS=�"`
Validated by:
.s�,
Signature of applicant .--/ Date
Mailing Address
Validation:
City, State, Zip %
A3.2%1 11 13 X518.76 CK
HARD COPY
CONSTRUCTION ESTIMATE Allilk
NO. ELECTRICAL F
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL I SO. FT. ®
GAS (ROUGH)
DRINKING FOUNTAIN
SQ. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
1/11GAS (FINAL) lH gV
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE i DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL" FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRYTRAY
AIR HANDLING UNIT 7 CFM
IKITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR I HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
I
SQ. FT. ®•c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID Q 1114 c
SEWAGE DISPOSAL
FIREPLACE
SQ.FT.GAR ® 3/4c
HOUSE SEWER
I
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
ROUND PLUMBING) 0�
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
T IITO S 1 Z (1Af5-
t_1 EWER OR SEP CTA
#ROUGH WIRING
V 7 /%6
!/
DUCT WORK
ROCK STORAGE
L) FOUND. REINF.i127-7
.Z /
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL I
1/11GAS (FINAL) lH gV
TEMP. POLE
GROUT I
WATER HEATER
SERVICE
FINAL INSP.
-BONDBEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
AL INSP..S /
•( �' FRAMING
FINAL INSP.
- ROOFING /All
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH f
ti //INSULATION/SOUND
FINISH GRADING 1
j�
FINAL INSPECTION
CERT. OCC. )
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL