002106 (SATT)401L
:
P.O. BOX 1504 No. 002106
Building 78-105 CALLE ESTADO
Address 901M 80-441.0k fir. LA,QUINTA, CALIFORNIA 92253
y
Owner . _.. .
Mailing
Address Yir e!nn x�er rice
City Zip " Tel.
Salm Miw 92260. W x2828 , . �.
Contractor
Address. . . .
BUILDING: TYPE CONST. OCC: GRP.,
A.P. Number
Legal Description
Project Description PM WM CR
City. -
Zip
Tel."'
Front Setback from Center Line
State Lic.
& Classif..
City
Lic. # 329
DM 1339
Sq. Ft. M 424
Size
No. No. Dw.
Stories • -Units
Arch:, Engr.,
Designer
New R Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
INSPECTOR
Issued by:
Date Permit
Validated by:
City
_. . . _..
Zip
. - •
State
Lic. #
LICENSED QONTRACTOR'S DECLARATION
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.
3 6 929=42- it .
.. ..
SIGNATURE .•' f d/«,':,Y bi:r+r-••.,r....•.w,a.•- ., ,DATE
' OWNER -BUILDER -DECLARATION
tEstimated
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 'tor such permit to rile a signed •statement .that he Is licensed pursuant to
the provisions or the Contractor's License L'aw, Chapter 9 (commencing with Section 7000) -of
Division 3 of the Business and Professidns" Cdde, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation or Section 7031:5 by 'any. applicant for a permit
' subjects the applicant to a civil penalty of not more than five hundred dollars ($500)' -
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
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
' 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 of 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
Valuation
I—
- ... PERMIT
-
- - AMOUNT '
"Plan Chk. Dep.- -
- - -
25-w00
Pian. Chk• Bal.
,�;� 94
•
ConSt.��,}
•
Mech..
9,t t^�'
34..00 ,
Electrical"
Plumbing
87ZO .
S.M.I.
..,
5.99
Grading
-
Driveway Enc.
Date Owner
Infrastructure
1,,76.00
WORKERS' COMPENSATION DECLARATION
1' 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.. .
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
2.1-79.'42 1,,929.12
,REMARKS
V
#
AM) ` wig. W L'"'mr �7ir'UO .iL;'•XW a
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 andstate'that the, above information is correct:
1 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'
r. _
Signature of applicant i-`'r+'y f /+ _ a Date
Mailing Address
City, State, Zip
HARD COPY 1
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 Permit
Validated by:
_
Validation:
A458U
3 6 929=42- it .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE /3 6
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
—EMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT S 2� �
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
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. (off c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
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 /' //�
// Bt7 Tr
GROUND PLUMBING 3 //
JNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /3 6
r.*UGH PLUMB. S /cf'/ljr
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR E� NKf/�OUGH
WIRING S �y�
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
/
REINF. STEEL3 //6 f .�i
GAS (FINAL)
—EMP. POLE
GROUT S 2� �
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM L2- 7 /�6�1
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING /� �j
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
,,0,6NSULATION/SOUND 5115-1-4L
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINIFIALS.
GARDEN WALL FINAL