002154 (SATT)P.O. BOX 1504 NQ. 002154
Building 78-105 CALLE ESTADO
Address RO- 673 081,r, TTiF-" LA QUINTA, CALIFORNIA 92253
Mailing
Address 7.5,005 COWAXy ClUb 4r.
City Zip Tel.
Palm a 92M I
.568-28n
Contractor
Wt1'H=boM= mid Land
Address _
'City lZip Tel...
State Lic.
& Classif. StR1
Arch., Engr.;
Designer
Address
Lic. #
M1
City Zip State
. .. Lic. #
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number.
Legal Description
Project Description PM WE FILM 2 0
Sq. Ft. x 1548 No. No. Dw.
Size GM 424 Stories I. Units I
New O Add ❑ ' Alter ❑ Repair ❑ Demolition ❑
O 1 am exempt under Sec. B. & P.C. for this reason
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. ❑ Certified copy is hereby furnished.
.00
AMOUNT
352.05.
42!.00 .
4.AA
65.44
97.58
G. 3
1.464.35
TOTAL 2,437.1.7
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed -if the permit is for 'one hundred dollars ($100) valuation wrff, xm := ww PAw (w mrs prpyw
or less.) -
I certify that in the performance of thg 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, alter making this Certificate of Exemption you should become
'subject 'to the Workers' Compensa0on 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 if work thereunder is suspended for 180 days.
.I car Illy 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 r r �f. " Date
Mailing Address
City, State, Zip r f
HARD COPY
ZON E:
BY:
. 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. ' f r . . -4 .
SIGNATURE '' y •r•'- '," �- .-. -+^ r^ra `+ DATE.•
OWNER -BUILDER DECLARATION
I hereby" affirm` hat 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
Estimated Valuation
97.62
- PERMIT
permit to construct, alter, Improve, dembfish, or repair any structure, prior to its issuance also
requires the applicant for such permit,,to rile 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 or the Business and Prolessions 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
INSPECTOR
-
. Plan Chk. Dep. .
' 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
Plan Chk, .Bal.
Const.
the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Code: The Contractor's License Law _does not apply to an owner of. property who
Mech.,
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
Electrical - 7
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.) -
Plumbing
❑ 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
S.M.I. '
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec. B. & P.C. for this reason
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. ❑ Certified copy is hereby furnished.
.00
AMOUNT
352.05.
42!.00 .
4.AA
65.44
97.58
G. 3
1.464.35
TOTAL 2,437.1.7
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed -if the permit is for 'one hundred dollars ($100) valuation wrff, xm := ww PAw (w mrs prpyw
or less.) -
I certify that in the performance of thg 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, alter making this Certificate of Exemption you should become
'subject 'to the Workers' Compensa0on 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 if work thereunder is suspended for 180 days.
.I car Illy 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 r r �f. " Date
Mailing Address
City, State, Zip r f
HARD COPY
ZON E:
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�4086 Permit -
.Validated by:
Validation:
A 4 6 4 6
3 10 2437,17. S1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EF&mk
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND.FL. SQ. FT. p
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
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
tt, UGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
(e JQWH WIRING 7
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROCK STORAGE
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 ® 114 C
SEWAGE DISPOSAL
WATER SYSTEM
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GRADING
CU. yd.
$ plus x$
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 GOND. SOLAR
SETBACK
rz6OUND PLUMBING 1Z3
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE '� Z�.
tt, UGH PLUMB.
ff6
G'
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
+1 WWER OR SE
(e JQWH WIRING 7
%
�+
DUCT WORK
ROCK STORAGE
FOUND. REINF. ,'j 00/
(/
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 -7171b071—e—
FINAL INSP.
///
ROOFING Fj/�'/Q/f /��
VENTILATION r
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
/� G
LATHING 7 l�
MESH
n L
n NSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
'
INSPECTOR'S SIGNATURESINITIALS
GARDEN WALL FINAL