002904 (SFD)P.O. BOX 1504
Building 55-245 jgDaCreek78-105CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253 .
Owner
Mailing
Address 75-005 00=fty Club Dive
CityZip Tel.
. Palm � 92260- 56B'2028 '
Contractor
Address
City Zip I Tel."
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description VM WW P&M 15- A
RM. 2mm1i
State Lic.
City
IXIG 1330
& Classif.�,
2t18a.
Lic. #
Sq. Ft.
Size 424
No. No. Dw.
Stories Units
Arch:;- Engr.,
Designer
New 1111� Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
r,LICENSED CONTRACTOR'S DECLARATION ".
I hereby affirm ttiaf l am licensed under provisions of Chapter 9 (commencing with Section.
7000) of Division.3 of the Business and Professigns Code, and my license Is in full force.and f
effect.�f ff
SIGNATURE_ 11 ! 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 'city or county which requires -a
permit to construct, atter, improve, demolish, or repair. any structure, 'prior to its issuance also
requires the applicant for such permit to rile 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 3of 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
'subjects the applicant to's 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
Estimated Valuation
244
� ��
_rt'
PERMIT'•
= AMOUNT
Plan Chk..Dep.
Plan Chk. Bal.
-
342.49_
Const._
-
do the woik, 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 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
or improvement is sold within one year of completion, the owner -builder -will have the burden
of proving that he did not build or improve for the purpose of sale.)
EI2CtrICdl
Plumbing'�C�
❑ 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.improves. thereon, and who contracts for
such projects with a contractor(s) licensed. pursuant to the Contractor's License Law.)
O 1 am exempt under.Sec. . B. & P.C. for this reason
S•M•1.
_62
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm'that'I have a certificate of consent io self -insure, or's 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.
TOTAL
_
.;REMARKS
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 tha 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.
ZONE: BY:
Minimum Setback Distances: - -
Front Setback frorn Center Line
Rear Setback from.Rear Prop. Line
CONSTRUCTION LENDING AGENCY.
Side Street Setback from.Center Line
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
FINAL DATE
Issued by:
Y.
Validated by.:
Validation:
A
INSPECTOR-
NSPECTOR-expiration
+aAry
Date sG / Permit
.
2 10 �.�6226. R
Lender's Address
' This is a building permit'when properly'fille'd out, signed and. validated, and is subject to
expirationif 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-. A
mentioned property for inspection purposes,_' I ��
Signature of applicant -_Date y
Mailing Address L �- i /
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL Ellillilikk
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
OUGH PLUMB. 5-_S C
9
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
i . GAS (ROUGH) s
DRINKING FOUNTAIN
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
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
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® IVa 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
SETBACK'2_11?_ _11?_
ROUND PLUMBIN 2
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 3�� J 1
OUGH PLUMB. 5-_S C
9
ONDING� _r
HEATING (ROUGH)
STORAGE TANK
UC, FORMS �/� —�
SEWER OR SEPTt3T
OUGH WIRING 5=5 ��^l
/
DUCT WORK
ROCK STORAGE
`GFOUND. REINF. _.� .^ _^�
i . GAS (ROUGH) s
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
,�REINF. STEEL—/21`�i \,
r
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
A&INAL INSP.
/
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_ $
LUMBER GR.
INAL INSP. (o—.2 F7
FRAMING '� s �7
FINAL INSP. r 1 C' S: t
V C�
ROOFING&rte (3/'�� �?^
T 1
eve To L,,.,
yI�(�v✓a6� ArW ��
v� n `' ^4,� �t�
ct
�` /��c� n�C
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING ^
MESH
INSULATIONISOUND 6"— 7—y9
FINISH GRADING
Al'TiNAL INSPECTION6 ; _
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL