08399 (CP)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 80-129 C6dw QM" LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 42-rM Cook St., Ste 200
City Zip Tel.
PDeb 92260 5W2828
Contractor ,
Batumi mrtime & L=d Co.
Address I
State Lic.
& Classif:
.-Arch., Engr.,
.Designer
Address
Zip I Tel.
Lic. # = 32$
el.
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 forceand
effect.
SIGNATURE r� !' .! ati. ,L-�' hj.,.f;•-� i he DATE
e
"'?l -r OWNER -BUILDER DECLARATION '
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
No. 08399
BUILDING: TYPE CONST. y - OCC: GRP.;
A.P. Number
Legal Description
Project Description
#P - 36�ta3
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
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
PERMIT
AMOUNT -
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 or the Business and Professions Code, or that. he is exempt therefrom, and the basis
'any
Plan Chk. Dep.
for the alleged exemption. -Any violation or Section 7031.5 by applicant for a permit
subjects the :applicant to a civil penalty of not more than five hundred dollars (5500).
Plan Chk. Bal.
❑ 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
Const.
Professions Code: The Contractor's License Law does not apply to an owner of property who
r� builds or,improves thereon and who does such work himself or through his own employees,=:
rovided that such improvements are not intended or offered for sale. If, however, the buildingMech.
le... P P
- 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, as owner of the properly, 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
-
' ❑ 1 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.Compa y l Ia
❑ Copy is filed with the city. ❑ er it ed copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
,rar,ea.y,r,rx ,r r: dP�•8x1 h,t�.•fad�,43.'i. 94
or less.)
�es1a iR7-��
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 of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Setback
Distances:
comply with such provisions or this permit shall be deemed revoked.
Minimum
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 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
INSPECTOR
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.
Issued by:
Date Permit
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SQ. FT. ®
OTHER APPJEQUIP.
REINF. STEEL
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WAiER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
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
REMARKS:
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® IVe c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
-MESH
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 S 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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
J� pJ
FINAL INSP. -7-5 C/
s
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