002891 (SFD)44
P.O. BOX 1504 No. 002891
Building 78-105 CALLE ESTADO
Address 55-3.74 2ml Creel LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: TYPE CONST. OCC: GRP:-
-� - '
Address
7r?cttav A.P. Number
City Zip Tel.
Palm Dewxt
960i$"e$ Legal Description
Contractor-
Project. Description
�' � 14 A
Address . .
Sam
City Zip Tel:
State Lic. City
& Classif. .� Lic. # 328 Sq. Ft. GkIt 424 No. No. Dw.
... Arch., Engr.,_. _
Size . - • Stories Units
Designer New 1J Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip state
Lic. #
LICENSED, CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9'(commencing with•Sect'ion
7000) of Division 3 of the Business and Professions Code, and my license is in full force an
effect."
SIGNATURE ' - s - f DATE _
OWNER-13UILDEIA DECLARATION Estimated Valuation.
I hereby affirm that I am exempt from°the Contractor's License Law for the following t r7� h�
reason: (sec. 7031.S,Qusigess and Professions Code: Any city or county- which requires a SS i ff .00
permit to construct, after,-. improve, demolish, or repair any -structure, prior to its issuance also - -
-requires the applicant for -such permit to Rte 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 c
Division 3 -of the Business and'Professkms. Code, 'or that. he is exempt therefrom, and the basin .
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'penatly of not more than rive hundred dollars ($5001. I Plan Chk. Bal.. .3C1ii R
❑ I, as owner of the property, or my employees with wages as their sole compensation, will 9Cl,•!!11s
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COfISt.♦��
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 hanself or through his own employees,
provided that: such improvements are not intended or offered for sale. If, however, the building Medh'.- . .34.1010
or improvement is sold within one year of completion, the owner -builder will' have the burden Electrical ��e'�
of proving that he did,not build or improve for the purpose of sale.) - - -
O 1, as owner of the property, am exclusively contracting with licensed contractors to.con- Plumbing • 87.50
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. . - 7.95
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.
Date owner Infrastructure 1#705.91
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 lumished.
TOTAL 2,751.21
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.)
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'thit 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 Liffe
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 if work thereunder is suspended for 100 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. r% / ' Validated by:
Signature of applicant rf + Date ' •�'✓ _
Mailing Address % Validation:
City, State, Zip %
A 7 2. 6 6 Z 1 2 1 U
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EWO,
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CARP. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
LCA& 0? �!0 —
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./EOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.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
94k*'IsETBACK [ G — d 7
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ��- Ll—
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
LCA& 0? �!0 —
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
REINF.�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
tQtEINF. STEEL _ ��
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
�(t(-'FRAMING Cl At G?
FINAL INSP.
(4,Z'1OOF}g,G �C Ll— C _
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
Ze'[ATHING L1—p% % b %
MESH
INSULATION/SOUND
FINISH GRADING
/(,,FINAL INSPECTION �+—�—
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL