002903 (SFD)44
P.O. BOX 1504 No, 002903
Building 78-105 CALLE ESTADO
Address 55'161 MM1+ LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING; TYPE CONST. OCC: GRP.
Address 75-005 QXMtX' ClUb Drive X
A.P. .Number
City
Zip
Tel.
Palm
9226p
568-2828
Legal. Description
Project Description
TIM I-m9p PEM is A
Contractor
kaiioiial i4Gl3` ga1Qa and 1,6jad
RM .4
Address
City . ._
Zip
Tel: _
State Lia
& Classif.:
City98
Lic. # 32114
Sq. 'Ft.
Size 424.
No. No. Dw.
Stories Units
Arch., Engr.,
Designer .
New IAdd O
...
Alter ❑ Repair ❑. Demolition ❑
r Address
Tel.
City
Zip
State
Lic. # -
LICENSED CONTRACTOR'S DECLARATION-,
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 ... J . r r `J -,"" 1p
SIGNATURE 4r - -" ./ "" DATE
OWNER -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 .ci:y 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 signedstatementthat he is. licensed pursuant 'to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
'Diviston 3 0/ the Business:and'Prolessions 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
' subjects the applicant to a civil penalty o/ not more than five hundred dollars'($500):
0.1, as owner of the property, or my employees with wages as theitsole 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,'
providedthat such improvements are not, intended or offered 'to., sale. If, however, the building.
or improvement is sold within one year of completion; the owner -builder wr'11 have the burden
of proving that he did not build or improve for the purpose of sale:) --
Estimated Valuation
�y
S 132 8161,00
t
-
PERMIT.
.
._ •.
AMOUNT
Plan Chk. Dep.
- -
-'
Plan .Chk. Bal.
442.73
t✓onst.
Mech.,
Electrical
- ws if�
/ _A .
Plumbing
.
O 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 of property who builds or improvesthereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - . .
O.Lam exempt. under Sec. B. 8 P.C. for this reason
' S.M.I.
_
Grading
Driveway Enc.
Date owner
Infrastructure
1,992.24
WORKERS' COMPENSATION DECLARATION
1 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
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is /or 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 California.
a
' —'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.
,ZONE:- BY: -
Minimum Setback Distances: ' -
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 i construction lending agency for the'performance of the .
work for which this permit is issued. (Sec. 3097, Civilcode.)
Side Setback from, Property. Line
Lender's Name
FINAL.DATE
:ISSUed by:
% Validated by:
Validation:
A 7 2 9 1
INSPECTOR
Date Permit
2 10 X15594 R
Lender's Address
• 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 car tify.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 ave-.
bo
mentioned property for inspection purposes. ,
Signature of applicant - { ' Date
Mailing Address ' T. r -
City, State, Zip r
'
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EF210k
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. 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
I&aOUGH PLUMB. 7_
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
.. AS (ROUGH) G�
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR,
SO.FT.GAR ® 3/ac
HOUSE SEWER
agFRAMING s -�i
INAL INSP. ��
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
Rd- SETBACK _.�
ROUND PLUMBING �
UNDERGROUND
A.C. UNIT
COLL. AREA
�C4SLAB GRADE _
I&aOUGH PLUMB. 7_
aCL ONDING r7_
HEATING (ROUGH)
STORAGE TANK
fl /.FORMS -,
EWER OR SEPTfg T r1
1
OUGH WIRIING
-, � _q 1
DUCT WORK
ROCK STORAGE
FOUND. REINF. ^1
.. AS (ROUGH) G�
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
�t4,REINF. STEEL-6—VI
66
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
INAL INSP. -.? -I'-7
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR,
/� nom, INAL INSP. 7�_S )
agFRAMING s -�i
INAL INSP. ��
LQ /ROOFING LI _a 3�' -7
f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
L �/INSULATIONISOUND
[rte
FINISH GRADING
FINAL INSPECTION 2 -7
I
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL