003179 (SOTB) r--- - ---� 28
J I IIIIII V I I I III
IE
P.O. BOX 1504 No, 003179
Building 78-105 CALLE ESTADO
Address 80-202 58th Avfm e LA QUINTA,CALIFORNIA 92253
Owner
IAMd=rk I A1Rd Comp$"
Mailing.
BUILDING: TYPE CONST. OCC.-GRP.
'
Address Ct, 0. Box 1000
A.P. Number PM we-at
CityZip Tel.
IA Quin 92253 564_304-4 Legal.Description
Contractor Project Description A t" if Cimmae 7Uintenance Facility
Address.
City Zip' Tela
State Ljc. City
&Classif. Lic.# Sq. Ft. No. No. Dw.
Arch., En gr: . ... . --
Size 0115n Stories • Units
Designer New E4 Add ❑ Alter❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic.#
LICENSED CONTRACTOR'S DECLARATION . ..
I hereby affirm-hat Lam licensed under provisions of Chapter 9(commencing with Section o+
7000)of Division 3 of the Business and Professions Code,and my license is in full force and
effect..
-
SIGNATURE DATE _
OWNER-BUILDER DECLARATION Estimated Valuation
&
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. .703 1.5,Business and Professions Code: Any city or county which requires ia !�
permit to construct, alter, improve, demolish, or repair any structure, prior to"its issuance also AMOUNT
requires the applicant for such permit to file a signed statement.that-he is licensed pursuant to PERMIT
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.tie 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). ' -
❑I,as owner of the property,or my employees with wages as their sole compensation,will. Plan.Chk, Bal. A Al _ima
do the work,and the structure is not intended or offered for'sale.(Sec. 7044, Buisness and CO 1St.
Professions Code: The Contractor's License Law does not apply to,an owner of property who Ar%1A_nI%
"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 AIz a CZ
❑ 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.M.I.
such projects with a contractor(s)licensed pursuant to the Contractor's License Law.) _
Grading
❑I am exempt under Sea B.&P.C.for this reason. -
Driveway Enc.
Date Owner Infrastructure 3 QRf�_11t
WORKERS'COMPENSATION DECLARATION
I'hereby affirm that I have a certificate of consent to'self-insure,or certificate of
Worker's Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.) '
Policy No. ' Company
❑Copy is filed with the city. ❑Certified copy is hereby furnished.
TOTAL
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 18;1.AFlIt 041}tf.1 WI il+��r-;t� y- 11
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 'ZONE: BY:
subject to'the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. - '
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-he
work for which this permit is issued.(Sec.3097,Civil Code.)' Side Setback from Property Line
Lender's Name
Lenders Address FINAL DATE INSPECTOR
This"is abuilding 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 A.1 A�R7 Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
IST FL. SO.FT.® $ UNITS
2ND FL. SO.FT.
YARD SPKLR SYSTEM
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. I SO.FT.Q
DRAINAGE PIPING
WALL SO.FT.
DRINKING FOUNTAIN
SO.FT.® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH)
APPLIANCE DRYER GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM KITCHEN SINK
ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET'
COMPRESSOR HP POLE,TEMIPERM 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®1114 c SEWAGE DISPOSAL
SO.FT.GAR®3/ac HOUSE SEWER
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.IEOUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP. CU.yd.
FRAMING FINAL INSP. $-plus-x$_=$
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 SIGNATURES/INITIALS.
GARDEN WALL FINAL