CSST (003461)56985 Madison St
003461
CA
P.O. BOX 1504 No.00346l.-
Building 78-105 CALLE ESTADO' ;
• Address 56-985 Madison LA QUINTA, CALIFORNIA 92253
Owner
TML of C -g ¢ioA. Tne-. /VCA Wxkmt BUI-LDING:,.TYPE.CQNST: .,OCC-. GRP.
Mailing
Address P. 0. Bog 10010 A:R: Number 761-080-008
City Zip Tel.
i.Et .i 9253 ,54--3044 Legal Description
Contractor Project. Description Rices Rewo t Course
X.V. ,Constrizetion .....0 ort Statim- at Nadisam' StreetTunnel-
Address
'City
Zip .
State Lic.
City
& Classif. 423636- '
Lic. #
133-.,----
Sq. Ft.' '. 685
No. No. Dw.
_ --- -
Arch., Erigr., _..- ... . _ ....
Arch.,
Size. ...
-Stories..-Units....
'. Designer
New ❑ Add'❑
Alter ❑ Repair ❑ Demolition,❑
Address
Tel.
#Ir36e A CM.I£Ot Station on -IV. Perimter uralm
City .
Zip
State . .
:tion iLmcls>..
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that )-am licensed under provisions of. Chapter 9 (commencing with -Section
•.7000) of Division 3<off the Business and Professions Code,'and my license is in full force and.--
effect..
SIGNATURE DATE
• ' . % .r^ 'OWNER—BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following$13,000,
reason: _(Sec. 7031.5,Business and Professions Code:. Any city or County.,.whlch requires a -
`permit
_
to construct, •after, improve, demolish, or repair* any structure, prior Yo its issuance also "
•
.. 'r, n _. -
•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 Section7000)of.
_;r
' Division 3 of the' Busirie'ss and 'Pro/essions .Code, or that. he is exempt therefrom; • and the "basis
for the alleged exemption. Any violation o/ Section 7031t5• by: 'any applicant for a •permit .,
-
. Plan. Chk. Dt?p.•m, . • •
-
., - .. '
subjects the applicant to a civil penalty o/ not more than Nve.hundred dollars ($500):' ` ; '
-•O I, the
.
Bal..
72
_ as owner of property,;or my employees with wages as.their sole compensation; will
do the work, and the structure is not intended for
_PlanChk.
,91T5 a
"
of offered sale: (Sec.. 7044, Buisness and
Professions -Code: The Contractor's License Law does nota Wan'owner
conSt', -.
r
•35 50
o! property who_
pp y pro ert
apply
builds • or 'Improves thereon and who does such work: himself or -through his •own employees,
'
.,
Mech. :"'
s
, p '
0
provided that such Improvements are not intended or, offered /or sale. If,. however, the building
• or improvement is sold within one year of completion, 'the -owner-builder will have the burden,
Electrical
•
- - •• -- -
25.00
of proving that he did not build or improve for the purpose o! sale.)
❑ 1, as owner of the property, am exclusively contracting with?licensed contractors to con- ,
Plumbing.77.00•
- 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:
• 1'.09. '
- such projects 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
• WORKERS' COMPENSATION DECLARATION
• I 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: (Sec. 3800, Labor Code.)' -
- -
. Policy No. -' Company .. ... -
O. 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 •($100) valuation
- • •
•- - -
• or less.)
• I certify that in the performance ofthq work for which this permit is issued, 1 shall not
•
- ' . ji k S.w; 6 a 94A p (}..,w—A 7 - }
-. employ any person in any manner so as to become subject to:the-Workers'Compensation
Laws of California.
'..
r -.
t Si r4: _ > E . : tS$ 3, JV:; , J t
Date ... ... Owrier
NOTICE TO APPLICANT: It, alter making this Certificate of Exemption you should become
ZONE:
BY: - `• ' `
subject to the Workers' Compensation provisions of. th`e 'Labor Code, you must -forthwith
_ Comply with such provisions or this permit shall be deemed revoked: -
Minimum Setback' Distanc' • -
Front S.etback:from Center Line
Rear Setback from Rear Prop., Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center.Line
hereby affirm thatthereis 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
LNSPECTOR
This is a building•permit'when properly tilled 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:
y."
/
Date 10/21A ermlt•= -
I agree to comply with' all city and'county ordinances and state laws relating. to tiuilding
l ,
construction, and hereby authorize representatives :;of this city to- enter the -above-.
v,
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
1ST FL. SO. FT. @ $
2ND FL. SO. FT. @
FOR. SO. FT. @
GAR. SO. FT. @
CARP. SO. Ff. @
WALL SO. Ff. @
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
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL' HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROUGH WIRING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
DUCT WORK
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
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
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
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. A3
FRAMING G ,,S
FINAL INSP.
ROOFING
Yv
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING —Q, C
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL