002145 (SATT)P.O. BOX 1504 No. 002145
Building 78-105 CALLE ESTADO
Address 80'13 Oak Mme LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75-005 0a Mb Dr.
City Zip Tel.
. palm naswt 92260 568-2828
Contractor
M0rb_qaq9 and'Land
Address
City Zip Tela
State Lic. City
& Classif.. 2$$ Lic. #2g�
Arch., Engr., "
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
effect. .1.. / . �� ,.,
1 ter- .i r. •/ ,
SIGNATUREi i, /' �• �� ' i 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 permit td 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 ($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:) -
'O 1, 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.)
❑ 1 am exempt under Sec: . B. & P.C: for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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.
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
1hereby 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.l 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 j jug 1- Date—
Mailing
ate Mailing Address
City, State, Zip f `
HARD COPY
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description � 1 3
REMARKS
wm. Awn 9PA STV PAW tv VIMS PRINM
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft. E` 1627
Size • . .224
No. No. Dw.
Stories i' Units
New.G7 Add ❑
Alter ❑ Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 3"40-46Permit
Validated by:
Estimated Valuation
$ 103,665.50
PERMIT
AMOUNT
Plan Chk. Dep.
3 10 X558%6 51
Plan Chk. Bal.
364.19
Corist.
443.50
Mech.
34.00
Electrical
67.41
Plumbing
87.50
S.M.I.
Grading
Driveway Enc.
Infrastructure
1,554.98
TOTAL
2.558-76
REMARKS
wm. Awn 9PA STV PAW tv VIMS PRINM
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 3"40-46Permit
Validated by:
Validation:
A4656
3 10 X558%6 51
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EFEWL
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
&UGH PLUMB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SQ. 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
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
�, ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
&UGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS-jCNER
OR SEPTI f
g-kOUGH WIRING 6117le
DUCT WORK
ROCK STORAGE
FOUND. REINF. i'
CJ
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.
ROOFING
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINRIALS
GARDEN WALL FINAL
9 p"t woort l 6/ZT-1%K 4? ,ems