04339 (SATT)U339
P.O. BOX 1504
Buildin 'Tanglewood 78-105 CALLE ESTADO
351
Address »,•LA QUINTA, CALIFORNIA 92253 M
Owner
su=ase Company
Mailing ,.,
BUILDING: TYPE CONST. OCC. GRP.
Address75-00S Country 'flub . DviVS A.P.- Number_ r - . .: � Nest - "TRE 4i EW$"
City Zip Tel.'
Palm DooetProject Description Legal Description
Contractor Phase id — plan B
• e
Address
City Zip Tel.
State Lic. City
& Classif. 288130 Lic. # 399 ., Sq..Ft. �No.•,< _ No. Dw:
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
n
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. r.-
. SIGNATURE DATE
' OWNER -BUILDER DECLARATION
Estimated Valuation
-hereby affirm that I am exempt from the Contractor's License Law for the following
—t
hz'reaaon: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
i.,. ,lpeimit. to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires,tne applicant for such permit to file a signed statement that he is licensed pursuant to
PER „AMOUNT ,
-ahe'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
•CYor:. 7031.5 'any for
Plan Chk. Dep. . •:
the alleged exemption. Any violation of Section by applicant a permit
- subjects the applicant to a civil penalty of not more than live hundred dollars ($500).
Plan Chk. Bal. A i � r►��
❑ 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.
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 of completion, the owner -builder will have the burden
Electrical
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 0�
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. '! Y{
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.
Infrastructure1a5��k�ti�I
DateOwner
WORKERS' COMPENSATION DECLARATION
AY®t i trasL"i►'u itu,6 a k"041 16a ZZ -VA
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
b Copy is filed with the city. ❑ Certified copy is hereby furnished.-
- _
TOTAL I..1
CERTIFICATE OF EXEMPTION FROM
REMARKS t
WORKERS' COMPENSATION INSURANCE
section not be if the is for hundred dollars
ilk 1
- • ;'}? axe., yGr a .:�'�' 'ix£ V
(This need completed permit one ($100) valuation
or less.) I
t!
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 California.
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
IT
FINAL DATE ' INSPECTOR.
This is a building permit when properly filled out, signed and validated, and Is subject. to
p i r4 C3 „
188
' expiration if work thereunder is suspended for 180 days.
i f22 f
Permit '
I certify that I have read this application and state that the above information Is correct.
Issued by: Date
- I agree to comply with all city and county ordinances and slate 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 Date
Mailing Address
Validation:._
City, State, Zip
WHITE - FINANCE PINK APPLICANT, GREEN BUILDING,
GOLDENROD - ASSESSOR'S OFFICE, HARD COPY,- FILE
'.
� ... Y',`:..,Ca a:: A.a, A.�'.?',.�, r'.',r.r:.,f .. �:. rt. :'. 7` s.r...cr..•.. ,.r.•rM,�- ... ,,.,<.M .. ._ .W [_t'
_T:!i?.f. .r...,... a....F.'eJ..• ,1 �;,•t.' .. _ - ...... .'.4: ..- .-rs+';i1.. kf. .,:='�"-i :S .,. -.. _ .c r.. s
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO Fl y $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT a
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Cl
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO FT. a
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. 0
_$
LUMBER GR.
FINAL INSP.
URINAL
SD. FT. Id
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
FIREPLACE
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.
SO. FT. ® c
BATH TUB
SO. FT. ®c
IWATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
HOUSE SEWER
f
CERT. OCC.
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 8 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 APPJEOUIP.
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
NA I TION
f
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
,
GARDEN WALL FINAL