002153 (SATT)44
P.O. BOX 1504 No. 002153
Building 78-105 CALLE ESTADO
Address 84-667 Oak TrW LA QUINTA, CALIFORNIA 92253
Owner
Slin rim La Wit$ O=xmw BUILDING: TYPE CONST. OCC: GRP:
Mailing
Address 75-005 CoyntrV CUb D. A.P. Number
City Zip Tel.
�3 � 56$_2$�'8 Legal Description
ContractorProject Description WI I 4Q
Watl Mirtm1nand%I
sam
"'City
Zip
Tela
State Lic.
Cityl��
& Classif.
Lic. # 328
Sq. Ft.
QW 24.
No. No, Dw.
Arch., Engr.;
Size -
Stories Units'
Designer-
New'[g Add ❑
Alter ❑ Repair ❑ Demolition ❑
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...
- _..
SIGNATURE s .!S .I'' « r' - . r. r. rev:- r, Cvr DATE
... .. ..
�! 't-'bWNER•BUILDER DECLARATION
_
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law. for the following
reason: (Sec. 7031.5,Business andjProfessions Code:. Any city or county which requires a
rpermif to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
�'�(����'�
'
,r
requires the applicant for such permitto file a signed statement that beds licensed pursuant to
PERMIT
AMOUNT
the provisions of the Contractor's' License Law, Chapter .9 (commencing with Section 7000) of
' Division 3 of the Business andrPiofessions Code, or that.he'is exempt therefrom, and the basis
Any Section 7031.5 'any for
Plan Ch Dep.
-
for the alleged exemption. violation of by applicant a permit
subjects the applicant to a'civil penalty of not more than five hundred dollars ($500).
-k.
Plan Chk. Bal..
❑ I,as owner of. the property, or my employees with wages as their solecompensation, will
• do the work, and the structure is not intended or•offered for sale. (Sec. 7044, Buisness and
COnst.
�f
. 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,
Mech.
'AA n0
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
Electrical!
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-
Plumbing
--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
•S. M.I.
Q 'AIM
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
-
.. ❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
1 -805-47'
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. ❑ Certified copy is hereby.furnished.
TOTAL
2.R91.56
_
CERTIFICATE OF EXEMPTION FROM
REMARKS.
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is. for one hundred dollars ($100) valuation
mA 1krm myp m
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: 8, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of 'the Labor Code,' you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
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
Lender's Address
FINAL DATE
INSPECTOR
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 this
Permit
read application and state that the above information is correct.
Issued by:
- Date
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. #
ter ...•,
`%�i
Validated by:
f r �' .�-.. - �- Date �•a
Signature of applicant
Mailing Address ! i` F r �;
Validation:
City, State, Zip
A 4 6 6 3
3 10 2891 56 Sl
L1 HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EFSII&
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE q
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF. q
//
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ. FT.
OTHER APP./EQUIP.
REINF. STEEL
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN
SQ FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
_ $
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.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
UND PLUMBING Z
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE q
l?Jft1GH PLUMB. -71310,
l
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
,
I f EWER OR !� (7T �
y
� _G_H WIRING / 2/
/
DUCT WORK
ROCK STORAGE
FOUND. REINF. q
//
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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 ` / kFINAL
INSP.
ROOFING L /j�-�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 7 07 ,;z4
MESH
12t!4f18ULATION/SOUND 7
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
J;re/ 44""77/ -7-D166"7e,