PAT (001623)Building
Address —$CQ AmMU
Owner
Mailing'
Address. smw
City Zip
Contractor
Address
92253
46-S55 MAKWId Pak
'City .. Zip....... ..
TA Qum 92253
State Lic.
& Classif. 300644
•Arch., Engr., -
Designer
Address
44
P.O. BOX 1504 NQ, 001623
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
Tela
345-77M
City
Lic. #
Tel
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description �`` L1 r,✓
Project Description
Sq. Ft. 42,2 •• NO. No. Dw.
Size .. Stories Units
New 3C Add ❑ Alter ❑ Repair ❑ Demolition ❑
City
Zip
State
.. ..
_. ._
.Lic. #
. LICENSED CONTRACTOR'S DECLARATION.
• I hereby affirm: that.l am licensed under provisions'of-Chapter 9 (commencing with'Section
7000) of Divisionof the -Business and Professions Code; and my license is in full force and/
+
,3
effect .� -a i f { tr y, "
s.
SIGNATURE I DATE
OWNER -BUILDER DECLARATION "
Estimated Valuation
hereby affirm that I am exempt from the Contractor's License Law for the following.:�a�.
Any
reason: ,(Sec; 7031.5,Busfness and Professions Code: city or county .which requires •a-
'permit to construct, alter, improve,_ demolish, or repair .any structure, prior to its issuance also
_
.y, -
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, Chapterr9 (commencing 'with Section 7000) of,.
.Division 3 of f/ie'Bainess and Professions Code, or that. he is 'exempt therefrom, and the basis
for the Any Section 7031.5 by 'any for
- - - -
Plin.Chk; Deji..
alleged exemption. violation of applicant a permit-
subjects the applicant to'a civil penalty of not more than five hundred dollars ($500). - -
Plan. Chk. Bal. 32.82
O I, as owner of the property, or my employees with wages as the ir•sole. compensation, will
do the work, and the structure is not intended or.offered for sale. (Sec. 7044, Buisness.and
Const. 50.50
. 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
of proving that he did not build or improve for the purpose of sale.)
O 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.. .. - 50
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
e
Grading
• ❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I' hereby affirm that 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. O Certified copy is hereby furnished.
TOTAL 8y82
_
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.)
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.
'. 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
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.Llne
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
DATE INSPECTOR -
. This'isa building permit when properly filled out, signed and validated, and is subject'to
.FINAL
expiration if work thereunder is suspended for 180 days. -
I certify -that 1 have read this application and state that the above information is correct.
Issued. by: Date 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 inspecctt'io�npurposes. , i
Validated by:
Signature of applicant /'J . »P 9I Date
.
Mailing Address �<< l" ) ��
Validation:
City, State, Zip
A1938 7 15 8382 Si
' HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEE.
IST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
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
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, 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 ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
REMARKS:
VENTILATION
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
s
?3RADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
4
-
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
/ INAL INSPECTION S
CERT. OCC.
FENCE FINAL
V A' J JIN 19N I V nC.7/11Y I I INLJ,
GARDEN WALL FINAL
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