002465 (BLCK)P.O. BOX 1504 NO. 2465
Building 78-105 CALLE ESTADO
Address 78"233 San TiMte LA QUINTA, CALIFORNIA 92253
Owner
t" BUILDING: TYPE CONST. OCC: GRP.''..
Mailing
Address A.P. Number��
Zip
City Tel.
7 A
�aD:-0,xintra 52253 - Legal Description '
Contractor Project Description
---------------
Address
P.C. B= 15%5 ... .. _ . .
City .. Zip Tel.. _
Palm splrizm 92263 325--5600 -
State Lic. City
& Classif. Lic. # � Sq. Ft. No. No. Dw. 29
. Size -•- Stories • Units
Arch., Engr.,
Designer New Cil Add ❑ - Alter ❑. Repair ❑ ' , . Demolition ❑
Address Tel.
CityZip State Lic. # �3..lin. a ft. E9f' a--� block
.. ... .._ ..... • .. ... .. -•
f t LICENSED CONTRACTOR'S DECLARATION ; j O
hereby affirm that I am,licensed..under provisions of Chapter 9 (commencing wrth'SectlFon/ -
7000) of Divisii{-on- oyf the Busliness and Professions Code, and my license is.in'fulll fdree and • n,
effect WAY. 'iW�aut"srr' ,1 ��`/ '
SIGNATURE Y K%1ry K'1 `✓ �`" • .I "J i A DATE - - - -'
r OWNER -BUILDER DECLARATION r, 7f Estimated Valuation ^
I hereby all I am exempt from the Contractor's License Law for the following
. reason:. (Sec. 7031.5,8usines6rand Professions • Code: Any city or .county which requires a-
permit -to construct, alter, improve, demolish, or repair any structure, prior to its issuance. also
. requiresthe applicant for such permit to file a signed statement that. heis licensed pursuant to PERMIT - -AMOUNT
the provisions of the Contractor's License Law, Chapter 9. (commencing with Section 7000) of'r: -
. Division 3 of the Business and Professions Code, or. that. he'isexempt therefrom, and thebasis. - ..
for the alleged exemption. Any ,violation of Section 7031.5.by'any.applicant for a permit Plari Chk..Dep..
subjects the applicant to a civil penalty of not more than fivehundreddollars ($500): . ' • - _ -
Bal:
Plan Chk. mit 0t�2
❑ I, as owner of the property, or my, employees with wages as their sole compensation, will. aG;J•
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and. -
•_ Professions Coder The Contractor's License Law does not apply to an owner of property who Const. - 38.5f1 -
builds or improves thereon and who does such work himself or through his own employees,
-- , Mech. 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
of proving that he did not bulld or improve for the purpose of sale.), - '
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
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. - ••
such -projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
O I am exempt under Sec.- B. & P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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.
- .. TOTAL 6;F.02
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 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, alter making this Certificate of Exemption. you should_ become ZONE: _ BY.: -t
'subject. to the Workers' Compensation provisions *of the Labor Code, you must forthwith' Minimum Setback Distances:
comply with such provisions or this permit Shall be deemed revoked. - - -
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 Id 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
This is a building permit when properly filled out, signed and validated, and is'subject to IFINALDATE, _ INSPECTOR'
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" Issued by: Date Permit - -
I agree to comply with all c1ly and county ordinances and state laws relating toybuilding -
construction, and hereby authdrke representatlyes sof this qity to enter the .-above- • • - _
mentioned property for inspecttori,purposes. gd /f}( /� -'f 1tf /' Validated by:
Signature of applicailf s 4� f .9v �L`,r l' Date /1 it/F/A•1,
Mailing Address �?' " `"r /' '� Validation: '
City, State, Zip '1 - I
A599U- 7. 18 6'4.62••U
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. 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 �! Z+
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.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
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.
SO. FT. RESID ® 1Ya c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS �! Z+
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL %/Z
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
fL/6OND BEAM 3(, S�
0
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
Y -FINAL INSPECTION
CERT. OCC.
FENCE FINAL
IMJYttiI VM"O W UNA I UMrWIN I I IALJ
GARDEN WALL FINAL