001626 (SATT)4 • `'� a 't inti
P.O. BOX 1504 No.. 001626
Building 78-105 CALLE ESTADO
Address 77-195 Menida ftrnandO LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address P.O. R= 780
City
Zip
Tel.
. $fit Qizinta _
92253
564--1375
Contractor -
an
_pli=
Address
81i =e
City . _
Zip .
Tel.'
S.M.I.
7.33
Grading
State Lic.
City
& Classif: 333752
Lic. #
-Arch:, Engr:,
Designer
Address Tel.
City JZip State
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,..
Vct.
SIGNATURE r•. +" .n J i DATE
;1— WNER•BUILDER DECLARATION '
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
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-
for
asis-for the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more'than five hundred dollars ($500). '
❑ 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
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,
provided that such improvements are not intended or offered for sale. If, however, the building:
orimprovement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve /or the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner o/ property who builds or improves thereon, -and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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.
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 lhg work for which this permit is issued, I shall not,
employ any person in any manner so as to become subjectTto the Workers' Compensation
Laws of Cali fornia.l�-
Date - //I" WJiOwner � ' I' err/f/ .%!
NOTICE TO APPLICANT: Il, /ter making this Certificate of Exemption/y'ou should become
subject to' the Workers' Compensation provisions o/ the Labor ¢odeyouyst forthwith
comply with such provisions or this permit shall be deemed revoked. f}•-' ��
CONSTRUCTION LENDING AGENCY
1 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 f
/purposes.
'r•
lsignature ofapplicant'/ �11 •fir E �1 E!�. a Date
Mailing Address ` r. Y" iir/" 1 f
City, State, Zip
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 631-720-048 14A 48
,Legal.Description
Project Description F-3 Tract 14495"'3 S.R.C.
Sq. Ft.: 2.:277 No. :- No. DIN.
Size -Stories 2 Units A
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT } -
AMOUNT
Plan Chk. Dep.
Plan Chk..Bal.
349 .An
Const.
448.00
Mech.
3.ici
Electrical�.25
Plumbing'.
52.50
S.M.I.
7.33
Grading
Driveway Enc.
Infrastructure
1.585.49
TOTAL
REMARKS
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 Permit
Validated bv:
Validation:
A202U 7 22 251,4,63 ft _
HARD COPY 1
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEE
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
{ROUGH WIRING
doJ�
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SO. FT. ®
HEATING (FINAL)
WALL SO. FT. ®
REINF. STEEL
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/.c
HOUSE SEWER
GAR. FIREWALL
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 7 Y
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
{ROUGH WIRING
doJ�
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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 &16t //P- 0 i -r'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL