001617 (SATT)0
4bf 4
4
P.O. BOX 1504 N o . 001617
Building 78-105 CALLE ESTADO
Address -05-457 P.G.A. Pled. LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: TYPE CONST. Q r OCC. GRP. n I
Address 75-$05 0=-Ary C Ub M. A.P. Number
City Zip Tel.
I'~ � =z 9226$ Vii$-2$2$ Legal Description
Contractor Project Description Pltl] 4 20 0
Address
City Zip Tel.
State Lic. City 3706
& Classif. Lic.# 328 Sq. Ft. bit~ No. I No. Dw.
Arch., Engr.,
Size �� Stories Units
Designer,j� Vt New [$ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
"It; Tr-A T.-.4111 C4.- T" n ill: l2.•ri91'9
City Zip State
=2j 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. I
Y-1 t A ?1
SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated Valuation
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 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 +i,CA ^a1
for the alleged exemption. Any violation or Section 7031.5 by any applicant for a permit plan Chk. Dep. `5n �"1)
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal.
❑ 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 Const. f
Professions Code: The Contractor's License Law does not apply to an owner of property who «83 M
builds or improves thereon and who does such work himself or through his own employees, Mech. Q
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 ��IR
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
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. V; %�
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc. -
Date Owner Infrastructure {jB�j,09
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
q�Copy is filed with the city. ❑ Certified copy is hereby furnished.
/ TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE yy ...wry �t A
(This section need not be completed if the permit is for one hundred dollars ($100) valuation �1 rau CM tnt iZ a..
or less.) .,.. j ,. r.�
I certify that in the performance of thg work for which this permit is issued, 1 shall not i z) � 'taJ.
of +� Aiia✓ � -
employ any person in any manner so as to become subject to the Workers' Compensation r
Laws of California. Z. kt.
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
Ihereby 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. 7-n&-`r
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. _ Validated by:
Signature of applicant t ' + Date '
Mailing Address Validation:
City, State, Zip
HARD COPY J
CONSTRUCTION ESTIMATE
All
NO. ELECTRICAL FE "
NO. PLUMBING FEES
IST FL. SO. FT. ®
UNITS
�ALAB GRADE T1.2 -47�JE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO 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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IKITCHEN 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 ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/4c
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 TLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
, //ROUND PLUMBIN /IqO1
UNDERGROUND
A.C. UNIT
COLL. AREA
�ALAB GRADE T1.2 -47�JE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC LANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
r
OUND. REINF.B 7Z?
Q)
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
</.JBAS (FINAL)/12 l
TEMP. POLE
GROUT
ab
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 SIGNATURESIINITIALS.
GARDEN WALL FINAL