002109 (SATT)Building
Address A
Owner
Mailing
Address ,
City
Contractor.
�i
Address.. ..
44
P.O. BOX 1504 No.- ()02109
78-105 CALLE ESTADO
r LA QUINTA, CALIFORNIA 92253.
BUILDING: TYPE.CONST. OCC: GRP.
Zip `• ITel
A. -R. -Number
Legal Description
Project Description PG% VM kM 2 Q
L:Iiy
Zip
Tel.
sam
Sam
State Lic.
City
& Classif:
288139
Lic. #
328
S Ft. ��
No. No. Dw.
�
Sze
Stories Units
Arch.; Engr.,
Designer
New Q Add ❑
Alter ❑., Repair ❑ Demolition .0.
Address
Tel.
City —7
City
Zip
State
Lic. #
. LICENSED CONTRACTOR'S. DECLARATION,
Y
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
r" effect. +. ! ..1 ,+
SIGNATUREf! - ,' x I` r,r+r' :rr .%,Y.d,.--".->« '_ '" DATE
:
_ .• -
"OWNER -BUILDER DECLARATION '
l
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
Estimated Valuation
ag • ,yjs p '_
i • b3 isLb ,
permit to construct, alter, improve, demolish, or'repair any structure, prior to its issuanceialso
requires. the applicant for such permit toafile 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-Prdfesslons Code, or that. he. is exempt therefrom, and *the .basis-
for. the Any violation Section 7031.5 -by 'any for
Plan.Chk. Dep:
- '
"250.00,
alleged exemption. of applicant a permit
subjects the'applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
��, ��
O. I, as owner of the property; or my employees with wages as their sole compensation, will
do the work, the
structure is not intended or offered forsale. (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,
Mech.' -
- -
provided that such improvements are not intended or offered for sale.. If, however; the buildings
or improvement is sold within one year of completion,' the.owner-builder will have. the burden
•-EleCtrlCal -
'" ��
of proving that he did not build. or improve for the.purpose of sale.) . ,
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing, -
87.50
struct the project. (Sec. 7.044, Business -and Professions Code: The Contractor's License Law
does not to who builds improves. thereon, for
S.M.I.
-
"
apply an owner'of property or and who contracts
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
..
Grading
- 6.193
❑ .I am exempt under Sec. B: ti: P.C. for. this reason
Driveway Enc.
Date owner
Infrastructure
1,464.35
WORKERS' COMPENSATION DECLARATION
J.. I hereby affirm that I have a certificate of consent to self,insure, ora certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)'
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
1 2.437.17 2,187,1.7
1 CERTIFICATE OF EXEMPTION FROM
REMARKS
_
I WORKERS' COMPENSATION. INSU RANCE
II (This section need not be completed if the permit is for one hundred dollars ($100) valuation
��^;Ta t��K }yyg �s��
x Al n d71�1F MT P i n PENUT
.I or less.) .. ._ .. .,
I •1 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
ZONE:
BY:
' subject to the Wbrkers' Compensation provisions. of the Labor Code,' you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: .t '
I
Front Setback,from.Center.Line
i
Rear Setback from Rear Prop.. Line
I CONSTRUCTION LENDING AGENCY
I -
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 .Pfoperty L_Ine '
Lender's Name
{ Lender's Address
FINAL DATE
INSPECTOR
1 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 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.
Validated by:
_
Signature applicant % � ' �
of Date •�'
i Mailing Address ` f! { �'
Validation:
_ ,
City, State, Zip f ! 7
/
A4576
3 6 �i87,17. it
i / HARD COPY
_ .. .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
COUGH PLUMB. f.ylldeBONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE MECH.FEE
FL.CK.FEE
CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK 31)1116- rr /I
IZ(AQUND PLUMBING?f
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 3 rZ
COUGH PLUMB. f.ylldeBONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SlIVER OR SE
WIRINGS
�j{
civ
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL 2
GAS (FINAL)
TEMP. POLE
GROUT S
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM 5t/2.7
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING �c�
FINAL INSP.
ROOFING le Ar
�/`�
t
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND s"
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESI NITIALS.
GARDEN WALL FINAL
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