001936 (SATT)4
P.O. BOX 1504 No. 001936
Building 78-105 CALLE ESTADO
Address 55-632 Oak 7rM LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. V OCC. GRP. R 3 .
Mailing
Address 7"05 0=vtry Club Driva
A.P. Number
City Zip Tel.
. . Pa3m Deseft 922260 56$-2928Legal Description
Contractor VATIM
�t—iXMI and- Project Description ' •D• !
NaftgaW
Address •
Plan 30 10
Sam
City ' Zip Tela
State Lic. City ;7FZIC MS 2825
& Classif.... Lic. # 328 Sq. Ft. 568 No. I No. Dw. j
Arch., Engr.,
Size - Stories Units .
� - - -
Designer Pd3ft-t Alm$ AM=A New X31 Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
15% rmilii, AV114. (7141 540-5117
City Zip State
t ^ e.E€`Viesa 92526 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that -1 am licensed under provisions of Chapter 9 (commencing with Section'
7000) iysion 3 of the Business and Professions Code, and my license is in full,force lforcand •, �„r
effect.. Div
SIGNATURE DATE
OWNEWBUILDER DECLARATION ' Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following$ -178,307.00
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 AMOUNT
requires the applicant for such permit to file 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 th'e Business and Professions Code, or thathe' 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 penafty of not more than rive hundred dollars ($500).
❑ I, as owner of the property,.or my employees with wages as their sole compensation, will Plan Chk. Bal. irz s.W
do the work, and the structure is not intended or offered for sale. (Sec. i044, Buisness and--COf1St���
Professions Code: The Contractor's License Law does not apply to an owner of property who . t +
SO
builds. or improves thereon and who does such work himself or through his own employees, Mech. i �, 55.00
Provided 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.)
O 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.L.�.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
39
0 I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 2,000,00
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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 1 3.485-17
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. If, 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. '
REMARKS
PMA .ATS? M WT Pt'3it'T OF TM Phi'
ZONE: BY:
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
This is a building permit when properly filled out, signed and validated, and is subject to FINAL.DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.��
I certify that I have read this application and state that the above information is correct. Issued by: Date ermit
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- y
mentioned property for inspection purposes: —Validated by:
Signature of applicant r - r .✓�_ .� Date ��,f!�
Mailing Address Validation:
City, State, Zip
A353L 12 1.0 ?48517 it
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FE-
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT, ®
CAR P. I SO. FT.
WALL SO. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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' 3 L
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
DOUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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 SIGNATURES/INITIALS
GARDEN WALL FINAL