002470 (SATT)• awc
P.O. BOX 1504 No 002470
Building 78-105 CALLE ESTADO
Address 5-5-850 pinehumt LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75-005 Ommtry Club Drive
City Zip Tel.
tl M.wr,.92260 568-2820
Contractor
Natl 1M.FaMM and %3d
Address
City S ]Zip I Tel.
State Lia I City
& Classif. 2MI30 Lic. # 323
Arcn.; tngr., -
Designer
Address Tel.
City Zip State
- Lic. #
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 infullforce and
-effect.
SIGNATURE N '?e 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
permit to construct, alter, improve, demolish, or repair anystructure,' prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
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.
subjects the applicant to'a civil penalty of nofmore than five hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation,. will
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
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;
orimprovement is sold within one year of completion, the owner -builder will have the burden
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-
struct the project. (Sec.• 7044, Business and Professions Coder The Contractor's -License. Law
does not apply to an owner of property who builds or improves thereon; and who contracts, for
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
Date Owner
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. ❑ 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.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
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.
I certify that I have read this application and slate that the above information is "correct..
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. _
Signature of applicant :� t ! '1'- �' `fes Date—
Mailing
ate Mailing Address
City, State, Zip f
HARD COPY
BUILDING: TYPE CONST"." OCC. GRP.
A.P. Number
Legal Description
Project Description FM tom' PHAM 2C
S.F.D. 21M 500 MR
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
DM 4263
Sq. Ft. 732
Size
No. No. Dw.
Stories Units
Side Street Setback from.Center Line
New Ck Add ❑
Alter ❑ Repair ❑
Demolition ❑
FINAL DATE
INSPECTOR
Issued by:
Date 7-23— Permit
Validated by:
Validation:
A 6 1 0 1
% 31 Sil,�l)7 CR
Estimated Valuation
A 767-477100
PERMIT
AMOUNT
Plan Chk. Dep..�{�
Plan Chk. Bal.
453.29
Con "St.853.00
Mech..
58.00
Electrical
$1.55
Plumbing
160..50
S.M.I.
1A.73
Grading
Driveway Enc.
Infrastructure
TOTAL
-A 455 n7
3,.705.07
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from.Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 7-23— Permit
Validated by:
Validation:
A 6 1 0 1
% 31 Sil,�l)7 CR
CONSTRUCTION ESTIMATE
NO. ELECTRICALAUS
NO. PLUMBING FEES
IST FL. SQ. FT. ® IFUNITS
2ND FL. `` SQ. FT. ®
FOR. SQ. FT. p
GAR. SQ, FT, ®
CAR P. SQ. FT.
WALL SQ. FT.
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ.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 TLUMB. 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
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL