002910 (SFD)P.O. BOX 1504 No. 00291€0
Building 78-105 CALLE ESTADO
Address 55'2257 C
Ilega LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75-005 Cbmitr * Club Drive
CityZip Tel.
.92264 568-4
Contractor
Address
City.. Zip Tel.
State Lic. City
& Classif. 288130 Lic. # 328
Arch.; Engr., - ...
Designer
Address Tel.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description VIM MT I` 1 A
PIM 3CR
LWLs Lulu d
Sq. Ft- GM 424 No. No. Dw.
Size • - Stories Units
New (9 Add ❑
Alter ❑' Repair ❑ Demolition ❑
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 3 of the Business and Professions Code, and my license isfull force and
.in
effect. J, .-�� . 1 _ � .. '�. •:a.' �, ., . � �f� .r� /�y �.i
4 ./DATE
SIGNATURE -` - - .!
-
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law.for the following
Estimated Valuation a�+� �q
8 !q6 d .00
reason: (Sec. 7031.5, Business- and Professions Code: Any city or county which requires a
,
permit to construct, after, improve, demolish, or repair any structure, priorrto its issuance also
• •
requires the applicant. for such permit to rile a signed statement that .he is. licensed pursuant to
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
0. '
DiRsion 3 or the Business and Professions Code,.or thathe is exempt therefrom, and the basis
for the Any Section 7031.5, by 'any, for
Plan.Chk. Dep.
alleged exemption. violation or applicant a. permit'
' subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
f d
rr. `i
Plan Chk. Bal.
❑ I, as owner of the property, or myemployees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec: 7044, Buisness and
CohSt. ��cs�sqV
. Professions Code: The Contractor's License Law does not apply to an owner- of property who
17
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 wdl have the burden
Electrical �7�b
or proving that he.did
id not build or improve for the purpose or sale.) _
e
❑ 1, as owner of the property, am exclusively contracting with licensed oontractors to con-
q
Plumbing 97..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.W.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
Grading
❑ .I am exempt under Sec.. - B. 8 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 furnished.
TOTAL. �L •
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S100) valuation
'
or less.) _
I certify that in the performance of the work for which this permit is issued, I shall not
r
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
comply with such provisions or this permit shall be deemed revoked.. • '
,Minimum Setback Distances: '
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 foi 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
FINAL DATE INSPECTOR
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 certify that I have
2—+- !! •qr
Z �
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 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 -/ c / Date-
Mailing Address i jaw
Validation:
City, State, Zip
`
A 7 2 8 6 2 10 21 U
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEF
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT.
SQ. 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
4oONDING . `!
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) l� 9
V
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRYTRAY
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
I� R y�n.ra
SQ.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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
CSETBACK •1 1 —q�/?
GROUND PLUMBING as�
UNDERGROUND
A.C. UNIT
COLL. AREA
F SLAB GRADE 3 -
OUGH PLUMBS:. ,5�_ b
4oONDING . `!
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPTIC N
OUGH WIRING C �S
7
DUCT WORK
ROCK STORAGE
FOUND. REINF.
UU
GAS (ROUGH) l� 9
V
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
INAL INSPf_2C(-5'
r�aa
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
�INAL INSP. 6 a L�- 0
v
24,CFRAMING C -+S^-
FINAL INSP.
6_A:5R00041� .2/"��
I� R y�n.ra
tL� �0 7 KG�L
ra
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
2C<LATHING H- b
MESH
eGKINSULATION/SOUND__^A
IFI
FINISH GRADING
e%KFINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL