002895 (SFD)Building
Address
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 7r,'Q05 00Y DtfVe
City Zip Tel.
Pali$ Desert 9mo • 568-2028
Contractor
Natictol ilmm Md ulave
Address..
City .. Zlp . Tel.
; c -m
State Lic. City
& Classif. 28811 Lic. # 328
:. Arch., Engr:; _
Designer
Address Tel.
City Zip State
_ .. .Lic. #
LICENSED CONTRACTOR'S DECLARATION,,.,
I hereby affirm -that I am licensed under provisions of Chapter 9 (commencing with Section'
7000) of Division 3bf the Business and.Professions Code, and.my license ,isinfull force and.r
effect./. t f �.� ` l �'r `.. r .l�_-Jj �f
SIGNATURE - 1 i' ,! .�' /DATE
.No.... 002895
BUILDING, TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description
Vy
N2 DR
Sq. Ft. GM 424 No. No. DIN.
Size Stories - Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
' OWNER -BUILDER DECLARATION
/
I hereby affirm that I am exempt from the Contractors License Law for.the following
reason:. (Sec. 7031.5,Business and Professions Code: Any city. or county which requires a
permit to construct, atter, improve, and,
or repair any structure, prior 4o. its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
Estimated Valuation
ds
'
PERMIT
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 the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
.Plan Chk. -Dep.
subjects the applicant to a civil penatty'of not more than rive hundred'dollars ($500).
_ ❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
Const.
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
Mech. .
builds or fmpioves thereon and who does suchwork himself or through his own employees,
provided that' such .improvements are not intended or offered for sale. If, however, the' building - .
Electrical
or improvement is sold within one year of completion, the owner -builder whit have the burden
of proving that he did not build or improve for the purpose of sale.)
Plumbing
O 1, 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 improves thereon, and. who contracts for
S.M.I.
such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
❑ I am exempt under Sec..B. B. & P.C. for .this reason
Grading
Driveway Enc.
Date Owner
Infrastructure
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
❑ 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 the 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
subject to' the Workers" Compensation provisions* 'of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
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.
1 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 purposes.
Signature of applicant �'{ Dats
Mailing Address
City, State, Zip
HARD COPY
TOTAL
REMARKS
)e A45JI
-AMOUNT
i
370.59
A55s50
34.00
65.44
87.5
. 7.60
1,628.18
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 by:
Validation:
A.726% 2 6. 264&8L C�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FE
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
�(et'SLAB GRADE 3 ^ L� -'�
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
4djNAL INSP. —C
6
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
JISIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
��(�RAMING G� �C��/�
0
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
�1
/[L�tOOFIN0/, /r
r—
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
GARDEN WALL FINAL
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
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
��ETBACK ltJ��7
ROUND PLUMBING � fi-�
UNDERGROUND
A.C. UNIT
COLL. AREA•
�(et'SLAB GRADE 3 ^ L� -'�
fZ�AOUGH PLUMBG(/ —.,S,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 12O
[(SEWER OR SE�IGaf K�
OUGH WIRINGGI—/6 ^�
DUCT WORK
ROCK STORAGE
e64�fOUND. REINF. Q !� !
v�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
/%�STEEL 3 — J��d
,"
h S (FINAL) 8
�✓EINF.
v
TEMP. POLE
GROUT
WATER HEATER
SERVICE
4djNAL INSP. —C
6
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$ _$
LUMBER GR.
INAL INSP^
��(�RAMING G� �C��/�
0
d(�INAL INSP. �� �Jf
�1
/[L�tOOFIN0/, /r
r—
REMARKS:
y),e A,, 14 •1e
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
/�INSULATIONISOUNDe,/ a(_� ,
FINISH GRADING
e4G4INAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL