001616 (SATT)4
P.O. BOX 1504 N o . 001616
Building 78-105 CALLE ESTADO
Address 55-435 P.G.A. 91mid. LA QUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: TYPE CONST. V r'' OCC. GRP. 'R 1
Address 75-M Cbtmtry Clt1h Dr.
A.P. Number
City Zip Tel.
Pain Dowwt 92260 We -292A Legal Description
Contractor Project Description Plan # 300 O
NhUargki lave & *orbaam OD.
Address
City Zip Tel.
State Lic. City
& Classif. Lic. # 3M Sq. Ft. 3957 No. No. Dw.
Arch., Engr.,
Size �� Stories Units
Designer New C* Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
2915 Pied 17M AIM. St. M7 7I4-540-5715
CityZip State
8 V �2 Lic: #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that Item licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of ttie Business and Professions Code, and my license is in full force and
effect ! •'r 1 • 11A�- I .
SIGNATURE ✓ DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License law for the following HeA
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a 2W 4.
00
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 PERMIT 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 +f�h.At�
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit plan Chk. Dep. 250 00 Cit+►
subjects the applicant to a civil penally of not more than five hundred dollars ($500). Plan Chk. BBI. 7,i.! J�yy sR4r
❑ I, as owner of the property, or my employees with wages as their sole compensation, will �r�
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 810.50
Professions Code: The Contractor's License Law does not apply to an owner of property who t'�
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 �b
Mech. „rrp,ey�
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical B3.14
of proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 148.50
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law y
does not apply to an owner of property who builds or improves thereon, and who contracts for S.W. 17.514
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec. B. t;. P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
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
(91Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL Jjasb.a 3,605.4d
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COM P ENSATION INSURANCE y�� ,,,� ��2� .�.�2a,
(This section need not be completed if the permit is for one hundred dollars ($100) valuation I,'f,R,J61C i� Wa � ii=i of big L�Ci.iilbi..
or less.) wt� �,.. 7be.,,
I certify that in the performance of thg work for which this permit is issued, I shall not No ama of bto AZ'= Own
employ any person in any manner so as to become subject to the Workers' Compensation^`y, -
Laws of California. \sirham ft
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
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 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 FINAL 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. # �y
I certify that I have read this application and state that the above information is correct. Issued by: —"/'� 7—U-85
�Date U— 85 Permit
I agree to comply with all city and county ordinances and state laws relating to building .t
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes. Validated by:
Signature of applicant ' 1 Date
Mailing Address Validation:
City, State, Zip
A 2 2 3 8 8 8 6,.548 Ck
HARD COPY
CONSTRUCTION ESTIMATE Alik
NO. ELECTRICAL E&J
NO. PLUMBING FEES
1ST FL. SO. FT. ®
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
.
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
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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
i ROUND 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) 3 6 J
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURE'S/INITIALS
GARDEN WALL FINAL