002762 (SPIN)W
- r
- 4
i yl
Building 51-573 ;Wt .ta ObVegm
Address
Owner
MADW
Mailing
Address240 YUM Ti
City Zip Tel.
Flullertion 32635 147141
Contractor
. Address
City
sam
State Lic.
& Classif.
Arch., Engr:,
Designer
Address
Zip
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 002762
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773'1214
449-4.SS2 Legal Description Lot 4
Project Description
Tel.''
City
Lic. # Sq. Ft.
Size
New ®a
Tel
No. No. Dw.
Stories Units
Add ❑ Alter ❑ Repair ❑
51
Demolition ❑
CERTIFICATE OF EXEMPTION FROM
..REMARKS
City
Zip
State
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
Lic. #
or less:)
_ 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 DATE
OWNER -BUILDER DECLARATION
Estimated Valuation.
I hereby affirm that I am exempt from the Contractor's License Law for the following
' Date Owner
. reason. (Sec. 7031.5,Business and Professions Code: Any cify or county which requires a
-
permit io construct, alter, improve,- demolish, or repair any structure, prior to its issuance also
requires the applicantJor such penmt:to file a signed statement that he..ls licensed pursuant to
PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with .Section .7000) of
"Divisioh 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
Any Section. 7031.5 for
Plan Chk..Dep.
for the alleged exemption. violation of by':any applicant a permit
subjects the applicant to a civil penalty of not more than'live hundred dollars ($500).
Plan. Chk. Bal.
❑ I, as -owner of the property, or my employees with wages as their sole compensation, will
CONSTRUCTION LENDING AGENCY
do,the woik, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
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.
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
EI2CtrICal
of proving that he did.not build or improve for the purpose of sale.)
This is'a building permit when properly filled out, signed and validated, and is subject to
❑ 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. .
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
r
Driveway Enc.
Date Owner �ie "�' "� r '�' "~^
Infrastructure
mentioned property for inspection puiposes: ` `'�' '-
VIM.
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure or a certificate of
Mailing Address f
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.
A6925
TOTAL
51
Demolition ❑
CERTIFICATE OF EXEMPTION FROM
..REMARKS
WORKERS'.COMPENSATION INSURANCE
(This section need not be completed it 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, 1 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
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 if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
'relating
Issued by:
Date Permit,
I agree to comply with all city and county ordinances and state laws to building
construction, and hereby authorize representatives of this city, to enter the above-
mentioned property for inspection puiposes: ` `'�' '-
Validated by:
Signature of applicant. ` J'+...._.Date
Mailing Address f
Validation:
City, State, Zip 1
A6925
12 16 i 0,00 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB'GRADE
ROUGH PLUMB.
r
2ND FL. SO. FT. p
HEATING (ROUGH)
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
HEATING (FINAL)
DRINKING FOUNTAIN
SO. FT. ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN 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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
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 PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB'GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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
g
1ND • 7
REMARKS:
t
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOU
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL