002993 (SFD)TitT 4 4 . Qawa
Address 77--165 AVS ArteaQa
Owner
lbe Fw1a3 t, (Sarna Rosa
'Mailing
Address P. 0. B= 66
P.O. BOX 1504 N0. ()02993
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC. GRP.-
A.P. Number MX— lot 28
CityZip Tel.
la'Q ixitas• CA 9U53 564-9101 Legal Description
Contractor
Address
City Zip
Palm D stx,, QA 9260
i State Lic.
& Classif. B 378318
Arch., Engr.,
I Designer MOM- Ba1.W En
I
Address
Project Description
t ta.47
City
Lic. # 189 Sq. Ft.No. No. Dw.
Size • oStories Units -
Tel.
New [ft Add ❑
• i»r-9va,r sx_�.s�cs..a
.a�csr--a�raw
... _
CityZip
State
PaIM -�: CA
• • 92260
I-Lic. # =912
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 f ,?'_tl h % ," t' �' i li % 1•,rn
,
SIGNATURE -'- DATE
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
Estimated Valuation
'
PERMIT.
-
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
Plan Chk. Dep. .
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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ' .
❑ I, as owner of the properly, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
Const.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who.
Mech.
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
or proving that he did not build or improve for the purpose of sale,).
Electrical
Plumbing
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or 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.) -
0 I am -exempt under Sec. B. & P.C. for. this reason
Grading
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 ' r • I - !, .A -! 'A, - .r a n • , -s- -/
% . 0 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 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
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
I1mestib t1m PC
TOTAL
REMARKS
Alter ❑ Repair ❑
Is542"
Demolition ❑
AMOUNT
470.45
8Q73y+.00
93.00
1.53.00
D.
1.9.23
20.00
200.00
1278.00
4 5045.74
Paul and Sm not 1rtct i
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
• . 1.11 . 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
exp
This is a building permit when properly filled out, signed and validated, and is subject to a
expiration if work thereunder is suspended for 180 days. 3%I.7187 Permit
I certify that I have read this application and state that the above information is correct. Issued by: Date
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:
. r
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
X7545 3 17 5 4574
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. 0 $
UNITS
COLL. AREA
SLAB GRADE
�
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
POR. SO. FT. 0
MOBILEHOME SVC.
BAR SINK
GAR. - SO. FT. 0
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. 0
Gf v
DRAINAGE PIPING
WALL SQ. FT. 0
HEATING (FINAL)
DRINKING FOUNTAIN
SQ FT 0
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
MING 7 / g %
/,
LAUNDRYTRAY
AIR HANDLING UNIT CFM
o,�/r�'
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. 0 c
BATH TUB
SQ. FT. 0 c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID 0 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR 0 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
TNST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUNPPLU I G
UNDERGROUND
A.C. LINT
COLL. AREA
SLAB GRADE
�
ROUGH PLUMB. i,% I
NG
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
Gf v
GAS (ROUGH) %l r1 t14? 79
7
i ER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE y �,
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
MING 7 / g %
/,
ROF1 6
�,
o,�/r�'
nY�X-
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