001752 (PAT)44 . 0
P.O. BOX 1504 No.. 001752.
Building78-105 CALLE ESTADO
Address U-295 Avenift Cbr"m LA QUINTA, CALIFORNIA 92253
Owner
MMIC+h F. BUILDING:. TYPE CONST. W. OCC: GRP. g 3
Mailing
Address A.P. Number 774-^241-014
CityZip Tel. •
La � 92253 fid --3564 Legal Description AM"M LOt 3
Contractor Project Description 12 3C 9e Rli-ies - Oxh PMA "%rim -r
Address
City. Zip Tel..
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Y
Size -.24O Stories Units
Arch., Engr.,.
Designer New Add,Add Alter ❑ Repair ❑ . Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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 E
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 file a signed' statement that he is licensed pursuant to
the provisions or the Contractor's License Law, Chapter'9 (commencing with Section 7000) oft
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 thework, 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 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O I am exempt.under Sec. • B.-& P.C. for this reason
Date
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
O Copy is filed with the city. 0 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 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, 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 if work thereunder is suspended for 180 days.
I car tify-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. •( �f / j
Signature of applicant',/ "1
Mailing Address
City, State, Zip
nwllsu 1L VrT
ZONE:
BY:
stimat6d Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal._
Const.
IS _ sn
Mech.
INSPECTOR
Electrical
Date fZ—?4 Permit
Plumbing
S.M.I. 7.
Validation:
Grading
A2940
Driveway Enc.
Infrastructure
TOTAL
SA (if)
REMARKS
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 fZ—?4 Permit
Validated by:
Validation:
A2940
1G 21 54,00 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO, FT. ®
CARP. SO. FT.
WALL SO. FT. ®
SO. FT, ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
m 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS .?3 kT
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR. SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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 .?3 kT
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION ''
CERT. OCC.
FENCE FINAL
INSNtUI UN'J WUNAI UMLWINII IALS,
GARDEN WALL FINAL