001629 (SATT)4
P.O. BOX 1504 No. 001629
Building 78-105 CALLE ESTADO
Address 77-165 Avenida ft�ID LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: TYPE CONST. OCC. GRP.
Address #P. vrywr 7R0 A.P. Number 631-720--051 Lot 51
City Zip Tel.
TA- Cli A 9M3 Legal Description
Contractor Project Description G-3 ilact 14496-3. S.R.C.
Address
'City Zip Tela
abaft
State Lic. City
& Classif.�?>2 Lic. If _ Sq. Ft. No. No. Dw.
Arch., Engr., Size If 2326,1 x Stories 1 Units 1
Designer New Q; Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section T
7000) of Division 3 of the -Business and Professions Code, and my license is in full force and-
effect.
nd-effect. ✓' �'
SIGNATURE ` N" ' -+ i' +' ./ DATE
OWNERBUILDER%DECLARATION
I hereby affirm that I am exempt"from h Contractor's License. Law for the following Estimated Valuation
reason: (Sec. 7031.5, Business and Professions Code: Any city, or county which requires a
5 A67 fin
permit to construct• atter, 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 thathe 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 of not more than five hundred dollars -($500).
[1 1, I, as owner of the property, or my_employees with wages as their sole compensation, will Plan Chk. Bal. 354.30
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const%
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. 26a0
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 Electricalb. ��
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 '73.00struct the project. (Seca 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. 7.34
such projects with a contractorls) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
i Date owner Infrastructure It:✓r4�.1l3, _
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 .
p Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 Californi-%101.
a {
Date �.r% ll)wn
TOTAL
REMAF
NOTICE,"TO`"APPLICANT: If, after -, making this Certificate`of Exemption .you-�shbuld/ba8ome
subject to the'' -Workers' Compensation provisions o/ the Labor Code;%' you mustf rthwith
ZONE:
BY:
comply with such provisions or this permit shall be deemed revoked. r,vim
Minimum Setback Distances:
•
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
Lenders Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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 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. X. _
' t
4
--Validated by:
'
Signature of applicant y�<','Pw ,,-,
t�11.� Date !� •`
X
MailingAddress ✓ # its-'
City, State, Zip
..,Validation:
A 2 0 2 3.
7 22 253360 R
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EEfin,
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
/ 1.L
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. Q c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
FMiiCRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.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./EQUIP.
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 // -
/ 1.L
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL