001943 (SATT)Building
Address
Owner
Mailing'
Address
City
P&IM
Contractor
55-500 Oak Trae
T 6 0
ei4t 4 Quk4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
. 92260 . 1,
558-2828
No. 001943
BUILDING: TYPE CONST. VN OCC. GRP. R3
A.P. Number
Legal Description
Project Description S.F.D. PIZ V
Plam 40 (W
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.
REMARKS �y�a yyy�yyy� /�jq
'—
Date Owner
City
lrtr
Zip
a
Tel:
a
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: -
State Lic.
& Classif.
City
Lic. # 328
DIC 3142
Sq. Ft. GAR A589
Size .
No. 1 No. Dw. 1
Stories Units
'Arch., Engr., -- - -
Designer WbWt A.tM= per.
New 0 Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
2915 Fe Imo. Am.
Tel.
(7140 543-5117
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.)
City
Zip
92626
State
Lie. #
LICENSED. CONTRACTOR'S DECLARATION
I hereby affirm 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;and
effect/ e
r
INSPECTOR
This is a building permit when properly filled out, signed'and validated, and is subject to
SIGNATURE DATE
rOWNER68UILDER
expiration it work thereunder is suspended for 180 days:
DECLARATION
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, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file 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 rive hundred dollars ($500). '
0. 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.)
O 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.)
. O I am exempt under Sec..B. B. & P.C. for this reason
Estimated Valuation
'
4�
$ 197,349.00
PERMIT
�� AMOUNT
-
- Plan Chk. Dep.
-
Plan Chk. Bal.
5"_39
Const,
L�f6 M
V lC7.iliJ
Mech.
r A1�A/�
55 .00
Electrical.
'¢�tj
Plumbing
50
S.M.I.
�"�{
Grading
Driveway Enc.
'
Date Owner
Infrastructure
2,10M.00
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 filed with,the city. O Certified copy is hereby furnished.
TOTAL„;(}„
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.
REMARKS �y�a yyy�yyy� /�jq
'—
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption youshould 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:
I certify that I have read this application and stale that the above information is correct.
Issued by:
Date '�''�'� Permit -
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- r
mentioned property for inspection purposes.
Validated by:
Signature of applicant �� /� Dated ��+ • 1
Mailing Address
Validation:
City, State, Zip
'
A 3 5 3 5
12 10 3j8t;.1� Ck
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FF,19&
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. I SQ. FT.
WALL SQ. FT.
SO. 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
WASHER(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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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
�OUGH PLUMB. % %� j
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS Tod wq
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL