002572 (SATT)94V
P.O. BOX 1504 No. 002572
Building 78 105 CALLE ESTADO
Address 55-92 'v$p?'^ LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75-005 COWr C ve
City Zip Tel.
Contractor
Address .. f _..
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description P. WYM-1. PEWE 3 C
kPUM 3100
Date Owner
NOTICE TO APPLICANT., ll, after making this Certificate of Exemption you shouldbecome
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 affiim 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 certify 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.
Signature of applicant r/iia,. , r Date
Mailing Address r J !yI rye .,r'. ,f'^
City, State, Zip %' W
al �.
e/r HARD COPY
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: Date4—IA—Ar, Permit
Validated by:
Validation:
A6315 9 10 3855,48 CI;
' City.... _ .. .Zip
sam
-
Tela .. .
State Lic.
& Classif.
City
Lic. #
32s-,
3971
S Ft.
Q" 6 .7
Size
No. No. DIN.288134
-Stories- Units
Arch., Engr:, ._ ..
Designer
New ❑g Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
_ LICENSED CONTRACTOR'S DECLARATION.
i. I hereby affirm -that l 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.
:?til, ! ". d . i?'• .�' "''s' � . , a ,..',/ / , .. � fes..
'
... ., ....
_SIGNATURE ,S' DATE
-OWNER-BUILDER DECLARATION
I her by�affirm that I -am exempt from the Contractor's License Law for the following
reason:Y (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 do its issuance also
requires the applicant for such permit to 'file a signed statement that he is licensed pursuant d
the provisions of the Contractor's ±License Law, Chapter *9 (commencing with Section 7000) of
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, witl..
do the work, 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.)
❑ 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. 8 P.C. for this reason
Estimated Valuation
r
2W
tS 4AID
-
�o .. PERMIT-
AMOUNT '
'
-
Plan C.hk. beti...
-
Plan Chk. Bal.
COnSt.
'
-Mech.
fes_
Electrical
'� '; g�
Plumbing
..
S.M.I.
_
Grading
-
Driveway Enc.
Date ' Owner
Infrastructure.i�Ji�.l
' WORKERS' COMPENSATION DECLARATION
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. (Seca 3800, Labor Code.)
Policy No. Company
O Copy,is filed with the city.. O 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 the 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.
'
TOTAL
REMARKS
Date Owner
NOTICE TO APPLICANT., ll, after making this Certificate of Exemption you shouldbecome
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 affiim 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 certify 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.
Signature of applicant r/iia,. , r Date
Mailing Address r J !yI rye .,r'. ,f'^
City, State, Zip %' W
al �.
e/r HARD COPY
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: Date4—IA—Ar, Permit
Validated by:
Validation:
A6315 9 10 3855,48 CI;
CONSTRUCTION ESTIMATE Allikk
NO. ELECTRICAL EESAMiL
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
2ND FL. SO. FT. @
.POR. SQ. FT. @
GAR., SQ. FT. @
CAR P. SO. 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 APP./EQUIP.REINF.
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.
SQ. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/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 APP./EQUIP.REINF.
STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
' r 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 .
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL