002134 (SATT)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 80-531 Oak T LA QUINTA, CALIFORNIA 92253
Owner
" 3#. � . _ I t
Mailing
Address .75--W5.0012-ftY MUb D'1v—!;%
City Zip Tel.
. . Palm Deswt 92MO r. n2g . .
Contractor
Address.,
Sam
BUILDING: TYPE CONST: OCC: GRP.•
A.P.`Number
Legal Description
Project Description PM W= P. I CIR•
City ... ..
Sam
Zip ...
Tel.. y ..
State Lic.
City
M n3O
& Classif. 280130
Lic. # M
Sq. Ft -M 424
Size
No. 1 No. Dw. i
Stories Units
,. .
Arch:, •Engr:,
New 0 Add ❑
- Alter ❑ Repair ❑ Demolition ❑
Designer'
Address
Tel.
City
Zip
State
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 force and
;, A , •/kl_ .I Y,
�' -
effectDATE
- - -
K
SIGNATURE ✓S - ,r • - "'" -
f..f.�. -
OWNER -BUILDER DECLARATION
I hereby°affirm lh"at I am exempt -from the Contractors License Law for the following
. reason:! (Sec. _ 7031. 5, Business. and jProlessions 'Code. Any ,city ,or county which requires • a ''►S..CSP
-permit' to construct, alter,. improve, demolish,'or repair any structure, prior 4o its issuance.also
' requires the applicant for such permit to We a signed statement that_he-is'licensed pursuant to
. the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
' D1VIS*Wn 3 of'the Busin'ess'and Professions Code, or that. he'is exeinpt therefrom; and 'the basis .
' 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 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
'
Estimated Valuation
3
vs pp }��yQp
•-
PERMIT-'
- _
AMOUNT -
-
Plan. Chk. Dep.
-
-
Plan Chk. 881.s
-
�. ,
COf1St..
iAD
Mech.
.
,l� �y
34.00
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
EIBCtrICal'
� -
•
or improvement is sold within one year of cornpfetion, the owner -builder will have the burden
of proving that he did not build or Improve for the purpose of sale.) _
Plumbing
87.5
O 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.)
... O I am exempt under Sec. - -8: & P.C. for this reason
S.M.I. •.
_
- - �
Grading
-
-
Driveway Enc.
Date Owner
Infrastructure
F?,
WORKERS' COMPENSATION DECLARATION
I' hereby affirm that I have a certificate'of consent'•to'self-insure; or a 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
2,179.42
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION. INSURANCE
�•- (This section need not be completed if the permit is for one hundred dollars (8100) 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.
'REMARKS'
REMARKS
�++ t�] ty�v �t�3
• ,L-Wed,IAC RX) PAA E70. rich
' 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.
ZONE: BY: '
MIf1lfnUm Setback Distances: -
Front Setback from Center. Line
Rear Setback from Rear Prop.. Line
corlsTRucnoN LENDING acENcr.
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 Property Line.
Lender's Name
FINAL DATE
Issued by:
Validated by:
Validation:
A4634
T
INSPECTOR
4p'�
Date i r?L3 Permit
3 10 L.I 19,42 Sl
-
Lender's Address
This'is a building permit when property. 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 '!,! _.-..�-�. Date -� ".�!' x�
Mailing Address r<�' -
City, State, Zip ' 1
' - HARD COPY
CONSTRUCTION ESTIMATE "\
NO. ELECTRICAL FQ1111116,
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT. (cy
WALL SQ. FT.
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS qw
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
UGH PLUMB./ a�'
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/4c
HOUSE SEWER
I� FRAMING aL n
FINAL INSP.
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
GROUND PLUMBINGL/
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEO54
UGH PLUMB./ a�'
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 11,12)111
/ /
SEWER OR SEPTIC TANK
P60UGH WIRING
5�k
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
I� FRAMING aL n
FINAL INSP.
)(-C ROOFING m d G�
Jr C
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
'
I /LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/IVITIALS
GARDEN WALL FINAL