002156 (SATT)4
P.O. BOX 1504 No, .002156
Building 78-105 CALLE ESTADO
Address 80-685 Oak Ttte LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75-005 QXMtrV C Ub rive
City I Zip ITel.
Contractor
City Sam
IZip Tel.
State
State Lic. City
& Classif. 288330 Lic. # 328
Arch., Engr., '
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE - i� �/.'r t 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 to rile a signed statement that he is licensed pursuant to
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
'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 or 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
or proving that he did not build or improve for the purpose or, 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 town 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
I hereby affirm that I have a certificate of consent to self:insure, ora 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
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 for inspection purposes.
l f
Signature of applicant � -'-•� _� i -fir...-,... Date- `7 `
Mailing Address !^ / f ? - !
City, State, Zip
/ HARD COPY
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description ' UM PIM 4 R
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft. M 424 No.
Size Stories
No. Dw.
Units
New 9 Add ❑ Alter ❑
Repair ❑ Demolition ❑
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 3'3-046 Permit
Validated by:
t
Validation:
Estimated Valuation
A 4 6 6 2
PERMIT
AMOUNT
Plan Chk. Dep. �.
Plan' Chk. Bal.
395.60
Const. . •
485.50
Mech.
34.00
Electrical
74 *69
Plumbing
,rjO
S.M.I.
8.30
Grading
Driveway Enc.
Infrastructure
1,80S.97
TOTAL
2891.56
REMARKS
P= Ate! SM Wr WWI € ` offs Pam
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 3'3-046 Permit
Validated by:
Validation:
A 4 6 6 2
310 '891,56 Sl
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EVoij,
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
I_ KOUGH PLUMB. `'
131*
YARD SPKLR SYSTEM
FOR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SD. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SO 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
=1NAL INSP.
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
SO. 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 IPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
FlIbROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
I_ KOUGH PLUMB. `'
131*
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
f( SEWER OR SEPTI
GH WIRING ?
DUCT WORK
ROCK STORAGE
FOUND. REINF. f
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.
=1NAL INSP.
FRAMING 7
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
VNSULATIONISOUND y ��
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIIN TIALS.
GARDEN WALL FINAL
VIZ -1'V -1l5/� ��