002216 (BLCK)Tw�t Q"_
44
Buildin
Address 54-920 Amid& Cam»
Owner
Dasext De i fc
Mailing
Address P.O. Box 1923
City Izip
. T Wnta
Contractor
ress. . -
State Lic.
& Classif. 456589
Arch., Engr.,
Designer
Address
92253
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No.. .002216
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774-295-009/010.
Legal Description Lot. 15116 (Ih v4rgbig Px+ mss 1XIO
Project Description
Tela
City
Lic. # 216 Sq. Ft. No. No. Dw.
Size Stories Units
New Ox Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel. -
Date Owner
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
❑ Copy is filed with the city. ❑ 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 thg 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 o1 Exemption you should become
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 affirm 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 it work thereunder is suspended for 180 days.
J 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 ins�pecfiori puoposes. ,!
Signature of applicant X. i`"Gff�, Date !s rcr
Mailing Address
City, State, Zip y
i �. ft. of vwd fie 8'tt= fes= 6"
If.of6•� .ids.
imated Valuation $ 41040.00
PERMIT •'•
Ian Chk. Dep.
Ian Chk. Bal.
onst.
Mech.
lectrical
lumbing
.M.I.
Grading
riveway Enc.
Infrastructure
TOTAL
REMARKS .
AMOUNT
.7f. • PG
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: Date APri.1 4•PerSit -
Validated by:
Validation:
A 5 0 4 1 4 4 8382 R
HARD COPY
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I 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. I .
SIGNATURE' DATE
•,
OWNER -BUILDER DECLARATION
Esti
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
requires the applicant for such permit to file a•signed statement that he is*.licensed pursuant -to
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
P
subjects the applicant•to'a civil penalty of not more than five hundred dollars ($500). -
P
❑ 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'
C
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
E
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-
P
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
D
Date Owner
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
❑ Copy is filed with the city. ❑ 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 thg 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 o1 Exemption you should become
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 affirm 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 it work thereunder is suspended for 180 days.
J 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 ins�pecfiori puoposes. ,!
Signature of applicant X. i`"Gff�, Date !s rcr
Mailing Address
City, State, Zip y
i �. ft. of vwd fie 8'tt= fes= 6"
If.of6•� .ids.
imated Valuation $ 41040.00
PERMIT •'•
Ian Chk. Dep.
Ian Chk. Bal.
onst.
Mech.
lectrical
lumbing
.M.I.
Grading
riveway Enc.
Infrastructure
TOTAL
REMARKS .
AMOUNT
.7f. • PG
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: Date APri.1 4•PerSit -
Validated by:
Validation:
A 5 0 4 1 4 4 8382 R
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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.
SQ. FT. ®c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
1` -// OND BEAM l' / �v
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 SIGNATURES/INITIALS,
GARDEN WALL FINAL