002228 (SATT)44
P.O. BOX 1504 No, 002228
Building 78-105 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner _
BUILDING: TYPE CONST. OCC..GRP.
Mailing
Address 7063 C=AXV Club DriVe A.P. Number
City lZip, ITel.
Contractor
Address . .
Sam
City
Zip - ITel
Legal Description
Project Description M �°�,ra� PLAN 40 0
AnSe 6 B .
State Lic:
City
= 3142
& Classif.
Lic. # 322
Sq. Ft. 5agNo. No. Dw.
Arch.; Engr.,
Size
Stories Units
' Designer
New Add ❑
Alter ❑ Repair ❑- Demolition ❑
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. `•' �,s. i
SIGNATURE : \ - DATE
s OWN ER•BUILDER'DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
�3
�� 7?3
reason: (Sec. 7031.5,Business and Professions Code: Any city or. county which requires ait
• ..
.
permto construct, atter, improve, demolish, of 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
PERMIT'S
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
' 703 'by' 'any. for
Plan Chk. Dep.
for the alleged exemption. Any violation of Section 1. 5 applicant a permit
' subjects theaapplicant to a -civil penalty of not more than five hundreddollars ($500).:
Plan Chk. Bal.
'
�`�•��y�
O I, as owner of theor m employees with wages as sole compensation, will �
property, y 9 p
do the work, and the structure is not intended or offered for sale. (SeL'7044, Buisness.and
COf1St.
6��•v
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,
McChr�•�
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
Electrical'
128.65
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-
Plumbing
/t/},�}
1BY,/.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.
13.83
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑.I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
n A
000.30
WORKERS' COMPENSATION DECLARATION
I'hereliy affirm' that 'I have's 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. O Certified copy is hereby furnished.
TOTAL
3.5%00-17
' 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 of Exemption you should become
ZONE:
- BY:
'subject oi to the Workers' Compensation provisions of the LabCode, 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
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.'
.FINAL
I certify that I have read this application and state that the above information is correct.
Issued by:
Date Permit
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;
Validated by:
Signature of applicant R ! -DateT_
Mailing Address ? _
Validation:
,.
City, State, Zip
A5118
4 8 8( 1 I CK
HARD COPY
CONSTRUCTION ESTIMATE Alkk
NO. ELECTRICAL FEEdIk
NO. PLUMBING FEES,
IST FL. SQ. FT. ®
UNITS
COLL. AREA
2ND FL. SQ. FT.
GH PLUMB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DRAINAGE PIPING
WALL SQ. FT.
FOUND. REINF.
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
OTHER APPJEQUIP.
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
BOND BEAM
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SO.FT.GAR ® 3/ac
HOUSE SEWER
FIREPLACE
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
AG OUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE / �� �/•-I`�
GH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
//[FORMS / %
G
WER OR SF�f T N®�
OUGH WIRING 1%1(9/
�g
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
%) ►MEINF. STEEL !
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP. Z/
BOND BEAM
WATER SYSTEM
$
L
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP. %�/
2
FRAMING 040/91l1
/0 1l e
FINAL INSP. /G
ROOFING 6ilk &6
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING Z/9 Aw, A44 -
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
/1/2,/ '...//
Vt r w�,/ /.1V/6/v /-I