08453 (SATT)PHASE • 37A' -BLDG:.. 21 .
P.O. BOX 1504 No: _ 48453
Building78-105 CALLE ESTADO "
" Address � � RIVIERA LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address
City
Contractor
:' • �# A'T tt a
Address ;
CDPANY BUILDING: TYPE CONST. OCC: GRP.• V
COOK ST RTF A.P. Number RSA WEST TRACT 21846-5
Zip Tel.
063
Legal Description
Project Description RmAs= of ALI Lim
Al MnOT4_rw r
w
I I-OWNER;BUILDER DECLARATION
I he eby.affirm teat: am exempt from the Contractor's License Law for the following
'.reason: ,r(Sec. 7031.51Businessand Professions Code4; Any city or county which requires a
Sq. Ft. 'r No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
• u
Estimated Valuation
9 w.) 0.1 C ;-wn
permit to construct, alter, improve,' demolish, or repair any structure, prior to its issuance also
City
Zip
Tela
PERMIT
AMOUNT '
Division 3 of the -Business and Professions Code, or that. he is exempt therefrom, and the basis
forthe-alleged,-exemption. Any Section 7031.5 'any
State Lic.
& Classif: `28WO
City
Lic. #
• Arch., Engr.,
Designer > "
Address
Tel.
CityState
Zip
-,rK.• Y_�
Lic. #
builds or improves' thereon and who does such work himself or through his own employees,
LICENSED CONTRACTOR'S DECLARATION
f <'I herebyy .eff m that; -am licensed under provisions of Chapter 9 (cotnrne
7000) of , Nision 3 of the Business and Professions Code, and my licensi
w
I I-OWNER;BUILDER DECLARATION
I he eby.affirm teat: am exempt from the Contractor's License Law for the following
'.reason: ,r(Sec. 7031.51Businessand Professions Code4; Any city or county which requires a
Sq. Ft. 'r No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
• u
Estimated Valuation
9 w.) 0.1 C ;-wn
permit to construct, alter, improve,' demolish, or repair any structure, prior to its issuance also
A WA.V t vV
requires the applicant /or such permit to file a signed statement that he is licensed pursuant to
the.provisions,.of theContractor's License Law, Chapter 9 (commencing with Section. 7000), of
PERMIT
AMOUNT '
Division 3 of the -Business and Professions Code, or that. he is exempt therefrom, and the basis
forthe-alleged,-exemption. Any Section 7031.5 'any
Plan Chk. Dep.
,
•. '
violation o/ by applicant for a permit
• subjects'the•applicant to a•civil penalty o/not more than five hundred dollars ($500).
-
- '
' p. I, as owner.of the property; or my employees with wages as their sole compensation, will
Plan Chk. Bal.
�3
,,
do the work; aridahe structure is not intended or offered for sale. (Sec. 7044, Buisnass and
COrlst.
• Pro/essions: Code.."The Contractor's License Law does not apply to an owner o/ 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.. Ir, however, the building
Mech.
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 /or the purpose of sale.) ,
-O I, as owner of, the property, am exclusively contracting with licensed contractors to con-
Plumbing
struct the project. (Seca 7044; Business and Professions Code: The Contractor's License Law
does not apply to an owner of propertywhobuilds or improves thereon,•and who contracts for
S.M.I.•`
projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
IF„•, , e.
,such
Grading
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.'
'DateOwner
Infrastructure
;
'ftt
• WORKERS' COMPENSATION DECLARATION
” "'
hereby affirm that I have a certificate of consent to self -insure, or a certificate of
sT IN r
• Y,s
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
f t
Policy No. Company
-
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
_
TOTAL
1 tai
CERTIFICATE OF EXEMPTION FROM
REMARKS
• WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the. permit is for one hundred dollars ($100) valuation
or less.) - `•
- I certify that in the performance of thg work for which this permit is issued, I shall not
r rar%•s a +n [°vat r.2_ a • • �= t .
employ any person in any manner so as to become subject to the Workers' Compensation
µ
..;i �$
Laws of California..
$) ,
O
NOTICE TO APPLICANT: ANTrIf, after making this Certificate of Exemptionyoushould 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
• Ihereby 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.
Issued by-
Date Permit
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.
Valldated.by:
Signature of applicant � Date'
-
Mailing Address
Validation:
City, State, Zip
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fpv.�,r •r'4 ,. •y"d �"^.:• 1''v-`� ..rp,'.t w-r-�'•r •�i.F .:.1.
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. S0, FT, ®
CAR P. SO. FT.
WALL SQ. FT. ®
SO. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAA EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
�,A,S (ROUGH),y
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING [�
FINAL INSP.
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
y -GROUND PLUMBINt-I/-v
UNDERGROUND
A.C. UNIT
COLL, AREA
LAB GRADE —�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR-6EP:RG-TANi(K
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
�,A,S (ROUGH),y
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.
L INSP.
FRAMING [�
FINAL INSP.
OOFING ��`y V
0,� 7-j /,^/,0
/—
/�
G`v-��/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
k)&SULATION/SOUND` 1�U6
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESHNITIALS
GARDEN WALL FINAL