002221 (SATT)Building W-563 le-' Se=h
Address
Owner
Mailing
Address
co=ems,,
t.. Drive
r r-oay.e
City lZip ITel.
Contractor
batt N=tgag>v3 mid Land
,.Address
City Jzip ITel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic. I City
& Classif. mno Lic. # 32
Arch., Engr., -
Designer
Address Tel.
CityZip 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. Tf
SIGNATURE 1 ' " - ri' .r t DATE
- / t,/ 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 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) or
DiJision 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.) -
D I, as owner of the property, am exclusively contracting with licensed contractors to con-
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
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'. COM PEN SATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
1 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 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 it 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. '
r
Signature of applicant / '^� �.idf' . 3 f r,.%:' Date {
Mailing Address
City, State, Zip ( f
,rr HARD COPY
No. aflr�
BUILDING: TYPE CONST. OCC: GRP
A.P. Number
Legal Description
Project Description ° '' # 20 OR
Sq. Ft.Q6 No. No. Dw.
Size .57% Stories 1 Units " i
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
.. r?:tdfSb
PERMIT
Plan Chk. Dep:
Plan Chk. Bal...
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
9A ^A
AMOUNT
495.15
.ydsa00y
232.50
11.24
Lp11:�:liwFis3
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 4 ?Sr Permit
Validated by:
Validation:
A5084
4 8 3394,95 R
CONSTRUCTION ESTIMATE 1,111111k,
NO. ELECTRICAL F
NO. PLUMBING FEES
IST FL. SQ. FT. ®
2ND FL. SQ. FT.
FOR. SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ. 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 Fi� se
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.IEQUIP.
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
FINAL INSP. /O 2/ �/'
�+
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
VENTILATION
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 �/ 'ji3
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 5 pQ BG
fak'9H PLUMB. ��
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS Fi� se
EWER ORS IR,15
GH WIRING 016 1,625
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
IiC-r JtREINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
An
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP. /O 2/ �/'
�+
FRAMING i8i t6 /9
4
FINAL INSP. �0 Z/ �7� �Z
v
/9
ROOFING
/-7 1!5
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
//THING
MESH
6SULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL '
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL