08026 (SATT)C&tyl 4.14
P.O. BOX 1504 N o . 08
Building. 78-105 CALLE ESTADO
Address 55-220 Riviera LA QUINTA, CALIFORNIA 92253
Owner
Sr3Seomday BUILDING: TYPE'CONST. ' ._-OCC: GRP.
Mailing
Address 00 Streat. Suite 20 A.P. Number Esa►rc idr...a
City;.. Zip Tel. ....
Palm Rpsea 922 Legal Description Tract NR46-5
Contractor Project Description
hacaa 36A Plan
hAtinnal,Land A Mirtgange
Address
City Zip TeL
r` State Lic. City
-& Classif.' 288,130 Lic. # 328 Sq. Ft. 1627 No. No. Dw.
Engr.,
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
'
l
City.:
Zip
State '
Lic. #ell
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9'(commencing with Section
7000)&f,Division 3 of We Business and Professsiiognst Code, and my licenseisinIfull force -and
,
' effete""'�i;i •..% �,lT-t '1r' .i t ,(.� �e"l~56g.1-•`>P i.
-
_SIGNATURE... '•�.•c,7 .7 • ,..y ., ... �r 1--7 'DATE
_ a
'OWNER -BUILDER DECLARATION f
Estimated Valuation
rt 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
- . o 1
requiresthe 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 of the Business and Professions Code, or thathe 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 of not more than five hundred dollars ($500). -
'❑
-
Plan Chk. Bal.'
I, as owner of the property, or my employees with wages as their sole compensation, will
' do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
COrt$t.
_- 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,
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 '
- of 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
'such
S•M•1.
pro)ects'•with a contractor(s) licensed pursuant to the Contractor's License Law.)
-
Grading
❑,I am -exempt under Sec. -B. & P.C.'for this reason
Driveway Enc.
Date Owner
Infrastructure d
'Less L 1220 43r. y
WORKERS' COMPENSATION DECLARATION
;
hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ore certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
}
•❑ Copy is filed with the city. 0 Certified copy is hereby furnished.
'
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
• WORKERS' COMPENSATION INSURANCE
-..,rk d " `f�' n
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(This section need not be completed if the permit is for one hundred dollars ($100) valuation
;�-f y j�,;f ,�1�. fi. F,r'
or less.) . '
I certify that in the performance of lhp work for which this permit is,issued, I shall not
'employ
1•
' any person in any manner so as to become subject to the Workers' Compensation
- - • • • -
Laws of California.
t
Date L r ` t O� Owner
NOTICE TO APPLICANT: If, after making this Certificate cf 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.,,
A
ISSUed by: Date 6125IMPermlt
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 theabove-.
mentioned property for inspection purposes.
Validated by:
' Signature of applicant Date
i
Mailing Address
Validation:
' City, State, Zip
y� �_ � � '. - q. -1 0 ''�'i r•5^ S 1- �e i� .7 rr.� 4 `� ,r..
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c.i' rx k �._ s �.,. c.r F.y _�.,�
,ti .. F.T.. �,. '?. - f... st +,a ��-�... ...?,f •. .. rr _3-"~- .._..
.. -+. 1,?:fi ryt-r� -� •• .. r.�-'�. 4,.,'.,:"''.1.t. .°„,-. „ .a
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO, FT. ®
CAR P. SQ. FT,.
WALL SQ. FT.
SOFT ®
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 usec as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAV EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT 14ALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
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.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. 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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
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.
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