002485 (SATT)P.O. BOX 1504 No. • 06.2485
Building 55-700 Mriel=- 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
,moi $YZissa. OMPMY
Mailing
Address 75-005 CMMtXV ClU DriVe
CityZip Tel. "
paim°t 92 .260568-
2
Contractor
dress ..
BUILDING; TYPE CONST. OCC: GRP:
A.P. Number
Legal Description
Project Description P.G.A. HOP PEFSE 1 C
9XV2. r4M 400 NR
raa>xxs
City ]ZIP
Tel."
State Lic.
City
) 4263
& Classif. �
Lic. # $
Sq. Ft. No. No. Dw.
Size -Stories Units
Arch., Engr., .. .
Designer
New ❑,. Add ❑
Alter ❑.• Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
_
Licr#
LICENSED CONTRACTOR'S DECLARATION
I hereby'affirm that l am licensed under provisions of Chapten9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. ' i , ; -7 ,. .
�.
SIGNATURE ,•Y. •I - DATE
='OWNER -BUILDER DECLARATION
I hereby aN0that I am exempt from the Contractors License Law for the following
. reason:' (Sec. 703 1..5, Business and,;Pro/essions Code: Any city or county which requires a. �
`permit
Estimated Valuation
"
267t427.00 '
h/_ PERMIT
AMOUNT-
MOUNT-the
to construct, alter, Improve „demolish, or repair any structure, prior to its. issuance. also
requires the applicant for such perinit to file a signed statement that he is licensed pursuant to
theprovisions o/ 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
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: D p...
-
250.00
-'
Plan Chk.`64_-
,
Const:
a �. 00
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 o/ 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
EIBCtrICal
.�
Se;
or improvement is sold within one year o/ completion, the. owner -builder- will have the burden-
o/ proving that he did not build or improve for the purpose o/ sale.)
Plumbing
�Py
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Seo. 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. -
' ' A. " 73
-such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec.- B. & P.C. for this reason -
Grading
.
Driveway Enc.
-
Date Owner
Infrastructure
2.(91ML00
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
❑ Copy is filed with the city. ..0 Certified copy is hereby furnished.
TOTAL
REMARKS
T CERTIFICATE OF EXEMPTION FROM
WORKERS'. COMPENSATION INSURANCE
(This section need not be completed if the permit is /or one hundred dollars ($100) valuation
-or less.) -
Icertify 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 o/ 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. ' -
ZONE: BY:
Minimum Setback Distances: '
-
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
FINAL DATE
INSPECTOR
Lender's Address
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.
+y: .�.��Qg
I certify that.l have read this application and state that the above information incorrect.
' I agree to comply with all city and county ordinances and state laws relating.to building
construction, and hereby- authorize representatives sof this city to enter the above-.
mentioned property for inspection purposes..
Signature of applicant) - %• ; �.L. Date t f
Mailing Address ` 1 % . -
Issued by:
Validated by:
Validation:
A 6 1 1 0
Date ff �ass<�r'"cy�JJ Permit
i 5-1 Si�5t�7 Cti
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRIC S
NO. PLUMBING FEES
IST FL. SQ. FT. ®
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.
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
FINAL INSP.
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, 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/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
4-
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
I INSPEG I UX'5 51UNAI UHL51INI I1AL5.
GARDEN WALL FINAL