003022 (SATT)P.O. BOX 1504 No. 003022
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC. GRP.'.
Mailing
Address 75-105 Country Club Drive A.P. Number
City ZipTel.
Palm- Desert 92260 568-2828 Legal Description
Contractor Project Description FGA West Phase 4B
National Mortmeame and Land
Address. TUM 40 M
City Zip Tela
State Lic. City D99 3142
& Classif. MUM Lic. # 328 Sq. Ft. No. No. Dw.
-Arch., Engr:,
Size 5� :Stories Units
- - - -
Designer New Q Add 0 Alter O Repair 0 Demolition O
! Address Tel.
City Zip State
- Lic. #
LICENSED,CONTRACTOR'S DECLARATION
N� / 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 forces d
SIGNATURE -` 7' - ¢– f .£ DATE,-
OWNER(BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following -25.•
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which, requires a it
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 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 rive hundred dollars ($500). �? • !
0 I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. d
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and CO�St.
• Professions Code: The Contractor's License Law does not apply to an owner or property who •
00
builds or improves . thereon and who does such work himself or through his own employees, Mech. §rj
provided that such improvements are not intended or offered for sale. If, however, the building 4p •
00
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical - i�6pwSYit
of proving, that he did not build or improve for the purpose of sale.) 4r
0 1, as owner of the property, am exclusively contracting with licensed.contractors to con-. Plumbing 140.50
struct -the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or property who builds orfimproves thereon, and who contracts for S:M•1,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
0 I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
c arsE�xassca
WORKERS' COMPENSATION DECLARATION r f` v• v. v
`! 6.,
i` I hereby affirm that I -have' a{certificate of •cons`ent to self•insure, L,, ycertificate;of%
Worker's Compensation. Insurance, or a certified•copy t�hereof(S c. 3800 LaborCodd.)"-
Pdlicy No.
0 Copy.is filed with the city. 0 Certified copy is hereby furnished.'
TOTAL�i5�
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 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 .Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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
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. �9
I certI,—ify that I have read this application and state that the above information is correct. Issued by: Date ` 2— J 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
A766Z._.. 4 S677,68 fl
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE S —�
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
s��6AS (ROUGH); ^�� /
' /
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
b%'3—�
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FIREWALL
SQ.FT.GAR g 3/ac
HOUSE SEWER
/ ./GAR.
5�ATHING
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
USSETBACK (� ,Q�
ROUND PLUMBING ,�
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE S —�
ROUGH PLUMB. 2/ )
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPTI 1
OUGH WIRING ��3�
DUCT WORK
ROCK STORAGE
FOUND. REINF.L/
s��6AS (ROUGH); ^�� /
' /
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL ��
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.INALINSID.
b%'3—�
RAMING
INAL INSP/U—a--fl
ROOFINCL_ .� ���a,.��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
FIREWALL
/ ./GAR.
5�ATHING
MESH
INSULATIONISOUND
FINISH GRADING
��CFINAL INSPECTION�11P
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL