001928 (SATT)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 55-782 Cak Trim LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 1I5-005 Q= Cblb Drive
City Zip Tel.
� 9 260 568-2828
Contractor
- Address
No. 001928
BUILDING: TYPE CONST. VN OCC. GRP. R-3
A.P. Number
Legal Description
Project Description S•P•D• PA VM
Plea 30Q
City '
Zip
Tel. -
Front Setback from Center Line
i
Sam '
SMS
Side Street Setback from Center Line
State Lic.
City
DM 2825
INSPECTOR
& Classif.
Lic. # 328
Sq. Ft. (M 568
No. No. Dw.
Validation:
Size
Stories Units
Arch., Engr.,
12 10 3485,17 R
Designer. �C2C•
New N Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address Tel.
2915 Rad HiU eve. MQ 540-5-U7
City
Zip State
' CmMIM
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 and
,forrce
effect. r
SIGNATURE DATE
Jr OWNER.BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
.t� ��'=liii
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
s' vV
permit to construct, after, improve,- demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement thaL.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
3. • .
Plan Chk.. bep:
p, is
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 live hundred dollars ($500).-
$500)'❑l,
Plan Chk. Bal.
0 1,as owner of the property, or my employees with wages as their sole compensation, will
do the work, and thwstructure Is not Intended or offered for sale. (Sec. 7044, Buisness and
Const.
630.50
. 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.
" �r
55.00
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
M.71
of proving that he did not build or improve for the purpose of sale.) - _
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
136.50
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not to who builds improves thereon, for
S.M.I.�..3A
+��-
apply an owner of property or and who contracts
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
- -
0 I am exempt under Sec: B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
2,00.00
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.
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.
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.
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 certify that I have read this application and stale that the above information is correct.
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 inspect ion'purposes.
Signature of applicant I / Date,/,-
Mailing Address /
City, State, Zip t
TOTAL 384$5.17
REMARKS
M" AM SPA PAW rp °moi.' S PRWW.
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 12/10/8513ermit
Validated by:
Validation:
A 3 5 3 1
12 10 3485,17 R
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EQ1111th,
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
2ND FL. SQ. FT.
FORMS
YARD SPKLR SYSTEM
FOR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
OTHER APP./EQUIP.
DRAINAGE PIPING
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN
SQ FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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
ROUND PLUMBING
UNDERGROUND UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
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.
$ plusx$
=$
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 SIGNATURES/INITIALS,
GARDEN WALL FINAL