002483 (SFD)TAT UW(*
P.O. BOX 1504 No, 002483
Building
Address 55-640 Pinehumt LA QUINTA, CALIFORNIA 92253
Owner I
_
BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 75-005 , fin, Club f va A.P. Number
CityJZip Tel.
DC
92260 568 --MB Legal Description
Contractor ��;��w ��y, y� Project Description �•�•�•� 4
R��11lO n�^mK2T:. F,a_.w R'Y�.d
S.F.D. FILM 100 11R
Address. .
City'
Zip
Tel..
?
State Lic.
City
MiG
3478&
Classif. 21381-30
Lic. # 328
Sq. Ft.
��'.' 696
No. No. Dw.
Arch., Erigr:;
Size •
•- Stories Units �.
Designer
New CIZ Add ❑
Alter ❑. Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
•
L•ic. #
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.
SIGNATURE - C .:' -•""' l DATE
.,
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt,from the Contractor's License Law for the following
ae�q� q��j /� '
°��.
$M,438.00
. reason: (Sec. 7031.5,Busfness and Professions Code: -Any' city or, county which requires a ''
Lig`�.7@•�V
permit to construct, alter, improve, demolish, or repair any structure, .prior to its issuance'also
requires the applicant. for such permit to rile 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. Any Section 7031.5 by 'any for
- Plan. Chk. Dep
alleged exemption. violation or applicant. a permit
' subjects the applicant to a civil penalty of not more than'rive hundred dollars ($500). '
Plan Chk. Bal.
• ®
Ry
O I, as owner of the property, or my employees with wages as their sole compensation, will
. • �7
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
w `�
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,-'
Mech..O
p•00
�,p�
- provided that' such improvements are not intended or. offered for sale: If, however, the building -
- �i¢7�
,or improvement is sold within one year of completion, the owner -builder. will have the burden
Electrical
4
of proving that he dfd.not build or improve for the purpose or sale.) ..
.E.4r
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
144.50
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. -
9
14.81
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
2sfWi .00
WORKERS' COMPENSATION DECLARATION
Ihereby 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.
TOTAL
3,665.02 3,,415.02
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: If, after making this Certificate or Exemption you should become
ZONE:
BY:
subject to the 'Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center. Line '
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.
�-L.i�c4A
I certify that I have read this application and state that theaboveinformation is correct.
Issued by:
Date - Permit
1 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
A6108
7 3 4 1 D,L2 CB
HARD COPY
i
CONSTRUCTION EStIMATEM,
NO. ELECTRIC S
NO. PLUMBING FEES
1ST FL. • SO. FT. ®
2ND FL. S0. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL S0. FT.
SO. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SO. FT. ® c
BATH TUB
SO..FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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./EOUIP.
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
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
`
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
1 UK'b b1UNA 1 UKLWINI I IALb,
GARDEN WALL FINAL