002474 (SATT)4
P.O. BOX 1504 N o .
Building O
Address 55555--NO��0 �LA QUINTA, CALIFORNIA 92253
Mailing
Address •9t$
City Zip _ Tel.
Contractor
Address
✓
City " Zip ITel.
State Lic. I City
& Classif.. ?Milan Lic. #
Arch., Engr.,
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 in full force and
effect.. f
SIGNATURE r DATE
OWNER;BUILDER DECLARATION
I hereby affirm that 1 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
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 not more than five hundred dollars'($500).
❑ 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
or improvement 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. (Seca 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 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
O 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 heieby 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 state 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
Date-
Mailing
ate Mailing Address ° dJ
City, State, Zip
HARD COPY
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description P_€LA- VIM PRI 2 .0
S.F.D. 321M 400 ;
Sq. Ft. 4263 No. No. Dw.
Size &R 32 Stories Units
New -H Add ❑ Alter 0-' Repair ❑ Demolition ❑
Estimated Valuation
267,427.00
Minimum Setback Distances:
PERMIT
Front Setback from Center Line
AMOUNT=
Plan Chk. Dep.
250.00
Side Street Setback from Center Line
Plan. Chk. Bal..
Side Setback from Property Line.
453-
Co6st.
INSPECTOR
853„0
Mech.
Validated by:
SR. all)
Electrical
Validation:
if. 1, _51s
Plumbing,
A6097
7 31 57,.567 CJ1\
S.M.I.
Grading
Driveway Enc.
Infrastructure
2.00.00
TOTAL
3.955.07
3,7705.07
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' 723�18CPermit
Validated by:
Validation:
A6097
7 31 57,.567 CJ1\
CONSTRUCTION ESTIMATE
NO. ELECTRICA S
NO. PLUMBING FEES
IST FL. SQ. FT. ®
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
E PERMIT SVC
EAMPERES
WATER CLOSET
COMPRESSOR HP
EMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. p c
BATH TUB
SQ. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. 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./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
CV 1 VA J JIV1�N1 VRLJ/IIYI I IXLJ,
GARDEN WALL FINAL