08036 (SATT)4t'4
r
P.O. BOX 1504 N o . 08016
Building 78-105 CALLE ESTADO
Address - >a;, ,, LA QUINTA, CALIFORNIA 92253 r
Owner
Stwise Powany I BUILDING: TYPE CONST. OCC. -GRP. -
Mailing
Address Stmet. Set t4a 9nn A.P. Number ..
City Zip Tel. @r+ rc
✓L3 • € 9'a t EiJ' �iF a Legal Description Tract 9ifil�. —5
Contractor Project Description Rhm- ? P1.An
n ItAnw ••
Address '"y"
City Zip Tela
.7'�State Lic. City
,& Classif. i Lic. # 3U Sq. Ft.13 No. No. Dw..,
'-Arch., Engr., - . '. , . - ,
Size Stories Units
Designer New ❑ Add ❑- Alter ❑ Repair ❑ -Demolition ❑
.u. -Address - Tel.
City Zip State ,.
t Lic. #
LICENSED CONTRACTOR'S DECLARATION
s I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Businessr and Professions Code,and my license Is ih•fulFforce`nncl
effect 4 ii ,.._ ;°%•^ f!1 �f �' j u++"'. °' •r<fr it 7
�.' SIGNATURE fJ = •/' +'} I '•DAITE
OWNER -BUILDER DECLARATION Estimated Valuation
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, atter, 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 PERMIT AMOUNT.
the provisions of. the, Contractor's 'License Law, Chapter 9 (commencing with Section 7000) of '
'Division 3 or 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 Plan Chk. Dep. -
subjects the applicant to a civil penalty or not more than rive hundred dollars ($500). • Plan Chk. Bal.
❑ 1, 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 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 Electrical
or proving that he did not build or improve for the purpose of sale.) .
•
❑ 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. I.' •" ''±
• such projects with a:contractor(s) licensed pursuant to the Contractor's License Law.) r
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
• Driveway Enc. '
Date owner, Infrastructure ..
cxed
WORKERS' COMPENSATION DECLARATION. $ ¢ �� •`
hereby affirm that I have a certificate of consent to self -insure, or a certificate of s
' Worker's Compensation Insurance, or a certified copy.thereof. (Sec. 3800, Labor Code.)
Policy No. Company
0 Copy is filed with the city. ❑ Certified copy is hereby furnished. .
TOTAL 2421.3 _)z
CERTIFICATE OF EXEMPTION FROM REMARKS I v
'WORKERS' COMPENSATION INSURANCE t�
(This section need not be completed if the permit is for one hundred dollars ($100) valuation -r j?r{� s o flt �•s x�e: a�" 'S rri"9q ,. •
or less.)
I certify that in the. performance of the work for which this permit is issued, I shall not
' employ anyy -person in anmanner 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 r 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 t
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 �f%gapermit '
I agree to comply with aI city and county ordinances and slate laws relating to building -
construction, and, hereby authorize representatives -of this city to enter the above.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip t
ti h,- j x < '
} a�: 4 7-. L� v� 1- �.rT r� vk d� +w9 t se {
r .. ..r, `pa �c .-.'~!., _.. \ cri, �"w, ='�-. } :� k'Y?. ,.w ,aG _�'-..�"r ♦�. �..{K a.y,a � •-S• wr `; ji<.;. .... .snr..•., r:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO, 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, 6T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SQ.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
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL