001857 (SATT)4
P.O. BOX 1504 No. .001857
Building 78-105 CALLE ESTADO
Address Ar4—A22 Oak `tom, LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 7 -5 -INS Chmtxv CIVA, DrivIa A.P. Number
City Zip Tel.
c4;�ft 1
92X() 56S_2M Legal Description
Palm nasaft
Contractor Project Description TIM tMEM N-IMMM
NM= Nat 11 Land and _M=tgage
Address
City
Zip
Tel.'
Sam
Sam
State Lic.
City
UIG'1627
& Clas sif.
Lic. # 3228
Sq. Ft. QW. 424 No- No. Dw.
1
.
Size Stories -Units
Arch., Engr.
Designer Fob=t Altevers Ass=
New Add 0 Alter 0 Repair 0 Demolition 0
Address
Tel.
2915 Mel, 1 Me.
VIA 540--5117
City
State
X; V=
0 4-1a . aw
lZip
.92626
Lic. #
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with.Section-"
7000) of Division 3of the Business:6nd Prcftssions Code, and my license is in fUll,fbrce and
effect -
SIGNATURE i �6 DATE
OWNER -BUILDER DECLARATIONn
e
Estimated Valuatio
I hereby affirmthat I am exempt from the Contractor's License L9w for.the following
103,665.60
reason: (Sec. 7031.5,Business d Professions Code:. Any city,county which requires a
and
.
permit to construct, after, improve, demolish, or repair any structure, prior to its Issuance also
requires -the applicant,tor such permit to file 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) of
Division 3 of the Business and Professions Code, or..that. he is exempt therefrom, and the* basis
Any Section 7031.5 'any for
Plan Chk. Dep.
for the alleged exemption. violation of by applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (S500).
Plan Chk. gal. 364.19
0 1 as owner of the property, or my employees with wages as their sole compensation, will
do ifie work, and the structure is not intended or offered for sale. -(Sec. 7044, Buisa6ss 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- through his own employees,
Mech.
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
Elec trical
of proving that he did not build or improve for the purpose.of sale.) .
0 1, 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 apply to an owner of property who builds or improves thereon, and -who contracts for
S. M. 1. 7- VER
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
0 1 am exempt under Sec. B. & P.C. for this reason -
Driveway Enc.
Date Owner
Infrastructure
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. ' Copany
m .
F1 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
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 thp 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.
MAW
Date__L_Own'e'r'
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
comply with such provisions or this permit shall be deemed revoked.
Minimum 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 it work thereunder is suspended for 180 days.
11 -134r -
I car . tify that I have read this application and state 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-.
mentioned property for inspection 'purposes. , - /
1. . , /-
Validated by:
Signature of applicant Date_!�!,
Mailing Address
City, State,' Zi
HARD COPY
Validation:
A 3 2 7 .8 11 13 255%6 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FE
NO. PLUMBING FEES
1ST FL. SO. FT. ®
2ND FL. , SQ. FT.
POR. SQ. FT. ®
GAR. SQ. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE. UNIT WALL FLOOR SUSPENDED
(�
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
/.FRAMING 3 �(� /a
1 `Y
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
:d
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 hy_Z&
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI
OUGH WIRING
DUCT WORK
ROCK STORAGE
�( `FOUND. REINF. jf ,
(�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
T I�\ REINF. STEEL
t,GAS (FINAL) tj Y�
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu: yd.
$ plus x$
_$
LUMBER GR.
g FINAL INSP.
/.FRAMING 3 �(� /a
1 `Y
FINAL INSP.
ROOFING 3
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SO U N D3
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
1 bFLU I VK'b WUNA I UN CS/INII IALS
GARDEN WALL FINAL
JJr.��r r