002139 (SATT)44
P.O. BOX 1504 No.
Building 78-105 CALLE ESTADO
Address- a&-561 Oak Trm LA QUINTA,.CALIFORNIA 92253
Owner
0.02139.
Mailing " BUILDING: TYPE CONST. OCC: GRP.
Address .C%.lb Drive! A.P. Number
------------
City I Zip Tel.
palm J)JaJ;f!ft. g f3 568--2828 Legal Description
Contractor Projecf Description PM Mm" Vym 2 tit
in
Address...... .
City Zip Tela
S
State Lic. City - MG 2548
& Classif.. $ Lic. # 329 Sq. Ft. No.
A h.'E
Size Stories
Qllk
No. Dw.
Units '
rc ., ngr.,
Designer New O Add ❑ ' Alter ❑ Repair ❑-..
Address
Tel.
City T
State
.I... Lic. #.
_LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section _ o
7000) of Division 3 of the Business and Professions Code, and my -license is in full force and
effect. . ._ t .. -...
01
SIGNATURE /! / i i i- • " • ++• �.;.+^' - _ Pi It
DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
1 hereby affirni'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, fmprove, demolish, or repair any structure, prior to its issuance also 'AMOUNT
requires the applicant -for such permit toyfile a signed statement that he'is licensed pursuant -to -PERMIT _
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of _ .s
Division 3 of'fhe'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 Plan Chk. Dep. -
Demolition.0
' subjects the applicant to a civil penalty*of not more than fivehundred dollars ($500).
❑•1, as owner of the property, or my employees with wages as their sole, compensation,,wiII
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
- Professions .Code: The Contractors, License Law does. not -apply to an.owrier 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
o/ proving that Ae did not build or improve /or, the purpose ofsale.) - . _
-❑ I; as owner of the property, am exclusively contracting with licensed contractors to con-
Strutt 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: B. & P.C. for this reason
•
Plan Chk. Bal.
Cof1St.
Mech. ...
Electrical '
Plumbing
S. M. 1.
Grading
Driveway Enc.
Date owner
Infrastructure
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
❑ Copy is filed•with the city. - O Certified copy is hereby furnished. .
TOTAL
.ryaa w v.i
427.00
34.00
65.44
87.50
6.•.83
1,464.35
CERTIFICATE OF EXEMPTION FROM - REMARKS,
WORKERS'. COMPENSATION INSURANCE n� !�!�
(This section need not be completed if the permit is for one hundred dollars ($100) valuation AM .W ' LWT WT CP P—MMT
'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.
Date Ownei "
NOTICE TO APPLICANT. If, after making this Certificate of. Exemption you should become ZONE: BY:
subject to the' Workers' 'Compensation provisions of the Labor Code, you must forthwith -
Minimum IRIUm Setback Distances
comply with such provisions or this permit shall be deemed revoked. - -
Front Setback from Center Line
CONSTRUCTION LENDING AGENCY
Ihereby 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'for,inspection purposes. i
Signature of applicant r1' ��f' +�•'9 �.r!:4 Date •�'�f
Mailing Address
City, State, Zip
Rear Setback from Rear Prop. Line_
Side Street Setback from..Center Line
Side Setback from,Property. Line
FINAL DATE INSPECTOR
Issued by: Date' Permit
JI.
Validated by:
Validation:
A 4 6 4 0
HARD COPY
T _
CONSTRUCTION ESTIMATE 'i
NO. ELECTRICAL F
NO. PLUMBING FEES
IST FL. SQ. FT. ®
UNITS
14 SLAB GRADE /
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IKITCHEN 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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
,L16mTHING
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 PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
14 SLAB GRADE /
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
ORMS rf
c�
44 WER OR SEPTIC LG�
UGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
FINAL INSP.
I -J. -ROOFING �%
Y
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
,L16mTHING
MESH
� INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL.
INSPECTOR'S SIGNATURES/INTIALS
GARDEN WALL FINAL
QIX— ,a (_v( VV rAU— '?,//- ((