002404 (BLCK)4
P.O. BOX 1504 No. 00240
Building78-105 CALLE ESTADO
Address 55-995PQ Blvd*, LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC..GRP.
Mailing
Address P_n_ Psi 10M A.P. Number
CityZip Tel.
a
Le o 92-53 564_3344 Legal Description
Contractor Project Description ft=v waU to TwMiS Clubhowe
Address.
S
City ]ZIP Tela
State Lic. City
& Classif. Lic. # ..Sq. Ft. 3w un No.
No. Dw.
1
Size Nfories Units'
Arch.,-Engr.,
Designer New QC Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State SME C$ �a A 4� mmm IN 'Ras fix:
... .. ._ . - 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--
f
.i � ;',.,.G:ag ,�:.•,....
SIGNATURE .—k -+::a -.» .•>' :., .x. •, f`..t Com:/ -Y,. -'.3�}7�::.F fi //" DATE
r`_ OWNER+BUILDER DECLARATION/
I herebyaffirm that I am exempt from the Contractor's License Law for the following Estimated Valuation 9G 0n
P 9� R>ir
reason: (Sec., 7031.5,Buslness and Processions Code: Any city or county which requires'a
permit to construct, after, 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) or _
Division 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 Plan Chk. Dep.
subjects the applicant to'a civil penalty oPnot more than five hundred dollars ($500).
❑ I, as -owner of -the property, or my employees with wages as their sole compensation, will.. Plan Chk. Bal. 4G0.62
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 62•
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, . Mech. '
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year or completion, the owner -builder will have the burden Elegtrical
of proving that he did not build, or improve for the purpose of sale.) -
O 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 M. I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -'
Grading
O 1 am exempt under Sec. B. 8 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
❑ Copy is filed.with the city.. ❑ Certified copy is hereby furnished.
TOTAL 103.62
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.). _
1 certify that in the performance of the work for which this permit is issued, I shall not
employ anyperson in any manner sous 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
'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 if 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.
Signature of applicantk Date i
Mailing Address . 6 '...C..�3"`i`. , , = ,[.
City, State, Zip ty v:
HARD COPY
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 6-10-Wermit
Validated by:
Validation:
A5751
6 10 I t.362 4
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT, ®
CAR P. I 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
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.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
insrec AnaDwnAIUneWmIiIAw,
GARDEN WALL FINAL