001942 (SATT)44
P.O. BOX 1504 No. 001942
Building 78-105 CALLE ESTADO
Address �3� 3 LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. VN OCC. GRP. R 3
Mailing
Address 75-005 CM*ry C,Uj Drina A.P. Number
City Zip Tel.
Palm 92260 5Gg_2 2g Legal Description
Contractor Project Description S.P.D.Im law
ifttimul Lad and 1-2)rtTme
Address pim 10 OR
City Zip Tel.
it N p
State Lic. City� s T2
& Classif. Lic. # 328 Sq. Ft. {M 582 No. No. Dw.
Size -Stories Units
Arch., Engr:,-
Designer Pgk*_rt A.tM*X8 Ate. New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
2915 ' RIM RM Ave.714) - a4Q-SU7
City Zip State
eta i88 92626 Lic. #
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,forde and,
effect. \l✓�,�'"•. � ,r.; J � .
SIGNATURE A `" ,/" P --DATE
CC OWNER -BUILDER DECLARATION Estimated Valuation
1 hereby affirm that I am exempt frorfn the Contractor's License Law for the following 144,517.00
reason: (Sec. 7031,5,Business and Prole'ssions Code: Any .city or county which requires a
permit to
thconstruct, alter, improve, demolish, or repair any structure, prior touts issuance also AMOUNT
requires e applicant for such permit to rile a signed statement that he is licensed pursuant to .PERMIT
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 Plan Chk.. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).' -
❑ I,as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. ' A 462.89
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 improves thereon and who does such work himself or through his own employees, .Meeh..��
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 Electrical -
of proving that he did not build or improve, for the purpose of sale.) C�
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing M.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 S.M.I. -9.84
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. n
Date Owner Infrastructure 2400.00
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. ❑ Certified copy is.hereby furnished.
TOTAL 3.303.90
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation - PATWIA Wo SPA P"° 1t W 'iWq
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: 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 Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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.
1 certify that I have read this application and state that the above information is correct. 'Issued by:—Date "''OJ 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. j s r�.—f Validated by:
Signature of applicant �I �T i —kY. Dater l
Mailing Address Validation:
City, State, Zip % }
-� A3523 12 10 331,396 CK
HARD COPY
CONSTRUCTION ESTIMATE Allikk —
NO. ELECTRICAL E&EL
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. @
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
GAR. FIREWALL
SQ.FT.GAR Q 3/ac
HOUSE SEWER
LATHING
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
.ROUGH PLUMB. J �
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS %,I �✓
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL