001862 (SATT)44
P.O. BOX 1504 No. 001862
Building 78-105 CALLE ESTADO
Address 54-~252 Oak TZM LA QUINTA, CALIFORNIA 92253
Owner _
BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 75135 omatxy G txr.
A.P. Number
CityZip Tel.
PaintDeswt 92260 .5£8-2 Legal Description
Contractor Project Description ` Q
Nat • A S7
Address
"City Zip Tela
Sa
m Sam Sam I
State Lic. City
& Classif. Lic. # 229 Sq. Ft. DIM 1627 No. No, Dw.
Arch., Engr.,
Size 424 Stories i Units
Designer ftbeit AlteverS . Newer® Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
2915 RINI RM Me. • (714) 540-5117
CityZip State
� 92626 Lic. # -
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thatA am licensed under provisions of Chapter 9 (commencing with`Sectioh
7000) of Division.3'6f the Business and Professions Code, and my license is in -full force and
SIGNATU_RCE .f / DATE
' OWNEfi•BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation �y C
reason: (Sec. 7031.5, Business and.Professions Code: Any city or county which requires a 103,60AO
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such -permit to fife a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with. Section 7000) or
Division '3 of the Business and Prolessions 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 Plan Chk. Dep.
subjects the applicant to a civil penalty o1 not more than rive hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 443.50
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, 9A �Ati
provided that such fnprovements are not intended or offered for sale. If„Mech.
however, the building U 00
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.) �n
❑ 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 apply to an owner of property who builds or Improves thereon, and who contracts for JS.M.I. 7.1.8
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 1,554.98
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
O Copy is fited with the city. ❑ Certified copy is hereby furnished.
TOTAL 2,558.76
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 the 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, N, 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 properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity 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 slate laws relating to building ;.
construction, and hereby authorize -representatives -of this city to enter the above-,
mentioned property for inspectiori,purposes.
Signature of applicant % °: Dale
Mailing Address r
City, State, Zip
HARD COPY
REMARKS _
&"A,, i'.tLt►ai t."9.Ik".i`.'!LUtul3 y BtY,Yrt:y K's^.�w"'1:'.iliA
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 11-13 8-SPermit
Validated by:
Validation:_
A3Zi3
11 13 �55&76 CK
CONSTRUCTION ESTIMATE Idill k
NO. ELECTRICAL F
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. 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
A.C. UNIT
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
1 O MS �7- '6
LAUNDRY TRAY
AIR HANDLING UNIT CFM
EWER OR SE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
S (FINAL)
SQ.FT.GAR ® 3/ac
HOUSE SEWER
TEMP. POLE
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
GROUND PLUMBING [
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
1 O MS �7- '6
r i
EWER OR SE
C A
�j
%'
/
ROUGH WIRING
r
®�
DUCT WORK
ROCK STORAGE
f`FOUND. REINF. `
s�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
41
S (FINAL)
j/' Z� Lf6
!/
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ pIUS x$
=$
LUMBER GR,
INAL INSP. S
.�1 RFRAMING
FINAL INSP.
-V14ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
,i LATHING
MESH
INSULATION/SOUND y e�
v
' FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
1Nsrrc 1 Un s WUNA i unrsnNi I IAw,
GARDEN WALL FINAL