002111 (SATT)4
P.O. BOX 1504 No,. 00211.
Building 78-105 CALLE ESTADO
Address 80-387 Oak Trm LA QUINTA, CALIFORNIA 92253
Owner <.
Address 75-005 •+lth D.iVe •
City.Zip Tel.
P -ztX226 568-28218
Contractor
ress .
BUILDING: TYPE CONST, OCC: GRP.
A.P. Number
Legal, Description
Project Description FM MT VIM 2 Ok
City
I�
BY:
Minimum Setback Distances:
Front Setback from Center Line
Zip
Tela
Side Street Setback from Center Line
State Lic.
& Classif..
City
Lic. #
},
Sq. Ft.2
Size
No. No. Dw.
Stories Units
Arch., Engr.;
Designer
New Add ❑
Alter ❑: Repair ❑ . Demolition ❑ '
Address
Tel.
Validation:
City
. . . . . .
Zip
. . . .
State
Lic. # _
3 6 2a 87.17 it
_ 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.
,,Y
- •
"
SIGNATURE/ ;r rte'"Y _ t^- %xF. f s.• DATE
! OWNER.BUILDER DECLARATION
1 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 w requires a.
permit to construct, alter, -improve, and,
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 fora permit
subjects the applicant to a civil penalty ofnot:ioore than five hundred dollars•($500). -
"• O I, as owner of the property, or my employees with wages as their sole compensation, will
do the woik, and the structure is -not intended or offered for sale. (Sec. 7044, Buisness and
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 or sale:)
❑ I, 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.)
❑ I am exempt under Sec. B. 8 P.C. for this reason
Estimated Valuation
i
$ 97,.623.00hich
.. PERMIT
AMOUNT
:.Plan Chk. Dep:
MAO
Plan Chk. Bal.
-
102.05
Const.
427,01)Professions
a
Mech.-
Electrical
�ta's��
Plumbing.
97-50
...
S.M.I: -
-� 9-14
Grading
.
Driveway Enc.
Date owner
Infrastructure
1.564.35
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
0 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 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.
TOTAL 2_417A7 2.197,.17
'REMARKS
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject - to the Workers' Compensation provisions ' df 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 state 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 inspection purposes.
Signature of applicant
��/ .moi ♦. Date -Z-
Mailing
-Mailing Address
City, State, Zip 7
HARD COPY
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 96 Permit
Validated by:
Validation:
A4576
3 6 2a 87.17 it
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FJ ®
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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE ME:;H.FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK 3 1
GROUND PLUMBING7� /L �p
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /Z
,,,'
124OUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
/ ' HEWER OR SEPTI
UGH WIRING S /y�
r ,METER
DUCT WORK
ROCK STORAGE
FOUND. REINF. 3 �L iy �,
GAS (ROUGH)
LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL $ Z R
GAS (FINAL)
TEMP. POLE
GROUT 5 28
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAMS L7 9���
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING 5 /t/
FINAL INSP.
ROOFING 6�y/ep6r�
VENTILATION
..
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 5 A, 8(�
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL