002829 (CSCS)P.O. BOX 1504 No. 002829
Building
Address 78,•!477 Idghway Ill LA QUINTA, CALIFORNIA 92253
Owner
Fayrilmd ? ,
Mailing' BUILDING: TYPE CONST. OCC: GRP.
Address Simm A.P. Number
City Zip Tel.
la t, 92425 564-2448.. Legal Description
Contractor
Project Description
Address _.
P.O.BOX 2669
_.
JZip Tel.. - - .
palm ��t 9-226 SF4-=9548
State Lic. City
& Classif: 437359 Lic. # • Sq. Ft.. No. No. Dw.
. Arch.; Engr:, • " _ ._ _ .. .. . - ._.
Size Stories Units
Designer. New ❑ Add ❑ Alter Repair ❑ Demolition ❑
Address Tel.
City Zip State .om � l outlet. . _ . _ Lie. # . .
LICENSED CONTRACTOR'S DECLARATION z.
I hereby affirm that I am licensed under provisions of Chapter (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
..:�� J�1. �.e5'•i �••i°�A# . ' � gar.. �.s,.e �
SIGNATURE 41 _ DATE .. .. .. . .. -
OWNER•BUILDER ! DECLARATION Valuation
Phereby 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 PERMIT - G AMOUNT
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 Plan Chk. Dep. -
subjects the applicant to a civil penalty of not more than five hundred dollars ($500): -
❑ I, as owner of the property, or my employees with wages as their'sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
Prolessions 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:) •
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
•• slruct 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
❑ I am exempt under Sec. B. 8 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 20„00
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 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:. Il, after making this Certificate of * Exemption you should become , ZONE: BY: '
subject to the' Workers' Compensation provisions of the Labor'Code, you -must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked - . '
Front Setback from Centerline
' • 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
This'is a building permit when'properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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 d G7 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 purse
pos. _ ;
.... F , � =`� Validated by:
Signature of applicanDate
Mailing AddressM Validation:
City, State, Zip i
A 7 0 8 0 l 8 :Z0.00 _. 9
HARD COPY "
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SQ. FT. ®
SQ. 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
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
DUCT WORK
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SERVICE
SQ.FT.GAR ® 3/ec
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 APP./EQUIP.
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
y FIRE ZONE ROOFING
FIREPLACE
' SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH8/
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
I UM', WUNA 1 UM MINI IIALS
GARDEN WALL FINAL