002135 (SATT)44
537 P.O. BOX 1504 No. 009135
Building 78-105 CALLE ESTADO
Address 80 -IM Oak TV00 LA QUINTA, CALIFORNIA 92253
Owner
Slowxiw TA OLl.3Ya OMPW Mailing BUILDING: TYPE CONST. OCC: GRP.
'
Address 755"-005 cry C711Lb MLVS _ . A.P. Number
CityZip Tel. ,
. �! .� _ 9, O 568- 282II Legal Description
Contractor Project. Description iIMT MW 3
til Mbrbmwe and Unlid
Address
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
O 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 tha 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
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 it 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 four, inspection purposes. }/
Signature of applicant 1 l Y-' 1x ' ? �. Datef ' C -
Mailing Address A
City, State, Zip t
'r
HARD COPY
TOTAL 1 2.558«76
--- --------
REMARKS
ZONE:
BY:
Minimum Setback Distances:
City
Zip'
Tel.' .
Rear Setback from.Rear Prop. Line
State Lia
& Classif. 28th
City
Lic. #
1627
Sq. Ft.d 424
Size-
No. No. Dw.
Z
Stories Units'
Arch.., Engr., ... .
Designer
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
Validation:
City
Zip
State
Lic. #
. LICENSED CONTRACTOR'S DECLARATION _.
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)0f Division 3 of the Business and Professions Code, and my license is in full force and
effect. .' rl.. .
u•
'
�-
•
SIGNATURE i r - ,+°r r'eFz: / 1—DATE
A+ r
OWNER•BUILDER DECLARATION
affirmlfierebyythat 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 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 .for a permit
' subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
❑ 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
eon 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 confraclor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under.Sec. - B. & P:C. for this reason
Estimated Valuation
V �Q �j fr33. 60
: PERMIT
-
- AMOUNT
Plan'Chk. Dep.
Plan Chk. Bal.
364.19
COr1St.
9q C�
"3.50
' Mech.
3400
•
Electrical�,
.
Plumbing
87.50
S.M.I.
-
- 7.18
Grading
Driveway Enc.
Date Owner
Infrastructure
w�
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
O 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 tha 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
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 it 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 four, inspection purposes. }/
Signature of applicant 1 l Y-' 1x ' ? �. Datef ' C -
Mailing Address A
City, State, Zip t
'r
HARD COPY
TOTAL 1 2.558«76
--- --------
REMARKS
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 `Q"'IFs Permit
Validated by:
Validation:
A4.650
..3 10 _ 255&76 S1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FrAillilk
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
UNITS
COLL.<AREA
2ND FL. SQ. FT.
OUGH PLUMB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SQ. FT.
"
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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM t FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ®c
BATH TUB
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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
Le INSULATION/SOUND
FINISH GRADING
STRUCTURE PLUMBING EILECTRICAL HEATING & AIR COND. SOLAR
SETBACK �:.
GROUND PLUMBIN"�
UNDERGROUND
A.C. UNIT
B�
COLL.<AREA
SLAB GRADE 3 3
OUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS L/A /
SEWER OR SEPTIC TA14K
OUGH WIRING"
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.
,(FRAMING 6, C
FINAL INSP.
I, �''1v ROOFING �Jf 7 Q/
� VENTILATION
...
',
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
(,<tJ ATHING /
MESH
Le INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL