002121 (SATT)P.O. BOX 1504 No. 002121
Building 78-105 CALLE ESTADO
Address 84-423 Oak Tme LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. -- OCC: GRP..
Mailing
Address. 75-005 CbM*rY C _. A.P. Number
City Zip Tel.
Paw, � - %8-2828Legal Description
Contractor Project Description M MT PLM 3'mss
Khtl 1-tirbiam and Land
Address, . ....... . .. . I . - . . . _ . .
::1
saw
.... `IZip .. ...ITeI.
State Lic. City "
& Classif.: 2eeno Lic. # 32s Sq. Ft. 1627 No,
Size 424 • Stories
Designer New lab Add ❑ Alter ❑
Address Tel.
City Zip State
. .. .. . . - .. Lic:..#.. S
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am.licensed under provisions of Chapter 9'(commencing with Section
7000) of Division Tot the Business and Professions Code, and my license is infull force and -
effect... sF f j f r; �. . r%'/
SIGNATURE', Q gi F'-- "�" DATE
OWNER -BUILDER DECLARATION +
!
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
permit to construct, alter, improve,-. demolish, or repair any structure, prior to its •issuance also
requires the applicant for such peimit'.to file a signedstatement that he is licensed -pursuant to
the provisions of the Contractor's,License Law, Chapter 9 (commencing iwith Section 7000) of.
Division'3.'of the Business and Professions Code, or that. he is'exempt -Werefrom,'and the basis-
'for . the alleged exemption. `Any violation of Section 7031:5 by 'any applicant for a permit
Estimated Valuation
cr.
"-
PERMIT
Plan 'Chk. Dep.:
subjects the applicant to a civil penalty of not more than five hundredVollars'($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.. .
Const.
do the work; and the structure is not intended or offered for sale: (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does. not apply to an owner of property,who
-
Mech. .
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
Electrical
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 of sale.) . '
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
• struct the project. (Sec. 7044; Business and Professions Coder 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, .. .
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O.I am exempt under Sec. - B. & P.C. for this reason
Grading
Driveway Enc.
Date Owner.
Infrastructure
Front Setback from Center. Line
WORKERS' COMPENSATION DECLARATION
Rear Setback from Rear Prop. Line
•1 hereby affirm that I have a certificate of consent to self -insure, ora certificate'df
Side Street Setback from Center Line
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No: ' Company
'Side Setback from, Property Line
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
FINAL DATE INSPECTOR
No. Dw
units.- 1: '
1.
Demolition ❑ ,
Repair ❑
qq AMOUNT
.r `+.1
443.50
ATAl
• ?_LA
1.554.98
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
�yp.�
Jim NIN PAM IMP MS Pmw?
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_LOwnei
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
- BY:
' subject to the Workers' Comp'en'sation provisions of the Labor Code; you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
,ZONE:
.Minimum Setback Distances: '
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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 it work thereunder is suspended for 180 days.
386
I certify that I have read this application and state that the above.information is correct:
'city.
Issued, by: Date Permit
I' agree to comply with. all and county ordinances and state laws relating to building
construction, and therebyy�authorize. representatives of this city to enter the, above•.
mentioned property for insp}ection purpos�es�t.f ''�
Validated by:
Signature !\-�i'1�r� (y �� w++ r,
of applicant ii Date
Mailing Address
Validation:
City, State,.Zip it .r +P
a'
A456,4 3 6
_ 23_t,T'6 Ck
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
&,&UGH PLUMB. 5 /y1 -w
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SQ 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$
LAUNDRYTRAY
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MEGH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK G /,11
/-'%ROUND PLUMBING -/i
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 3 �Z �6 �[ y
&,&UGH PLUMB. 5 /y1 -w
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
S WER OR SEPT15, T H
R-AOUGH WIRING
/ /
DUCT WORK
ROCK STORAGE
FOUND. REINF. 3 Y47%
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUTS Q/�
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM s
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
�6RAMING S r /�
FINAL INSP.
ROOFING vC�
REMARKS:
.
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
/OeNSULATIONISOUND g
cam+
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL