04261 (SATT)i•' ,� �f.•-!'�4 'ryrei, .QRZ , il� ' ~ ,
Tit,
' > 'b ' ' _ !-• �' P.O. BOX 1504
'Building �$d3 `iN�rra Cotta Ct • 78-105 CALLE ESTADO
Address.•• ` _ LA GUINTA,.CALIFORNIA 92253. - . -
Owner
BUILDING: TYPE CONST: OCC. GRP.
Address—.
777-.S. tarn 1St.. quite 106 A.P. Number 613-790-001
City Zip Tel. 4 <
Oraric 92686 '714- Legal Description
Contractor Project Description
_• Sam _ Pala Royale -- Plan 3
Address., -
City t r:� r Zip Tel.
State Lica City
& Classif... 462814 Lic. # - Sq. Ft. 763 No. � No. Dw.
Size Stories Units
Arch.,•Engr.,,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address- . Tel.
City Zip State '
Lic. #,
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in'tull force and
effect.;F/�n-
SIGNATURE - -` Y •.DATE
x.,yr
OWNER -BUILDER DECLARATION Estimated Valuation
' I hereby affirm that I am exempt from the Contractor's License taw for the followingt,$�`,�
reason: (Sec.,, 703 1.5, Business and Professions Code: Any city 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 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
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, penally of not more than five hundred dollars ($500).
❑'l; as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. rV'-►�. •
do•the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. ! 304 .00
`Professions Code:, The' Contractor's License Law 'does not apply to an owner of property who a7
builds: or, lrnpioves� thereon and who does such work himself or through his own employees, Mech.
provided that such improvements aie not intended or offered for sale. If, however, the building g+ y
or improvement;is sold within,one year of completion, the owner -builder will have the burden Electrical _ i 41 01/0
' e of proving,that,he`did not build or improve for the purpose or sale.)
1 •O 1, as ownei of. the property, am exclusively contracting with licensed contractors to con- Plumbing 63.4 0y,1n
struct the project.'„ (Sec_J044, Business and Professions Code: The Contractor's License Law S}
does not.apply to an,owner of property who builds or improves thereon, and who contracts for S.M.I. 3 r 96
such projects with a confractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt.under Sec. B. & P.C. for this reason
Driveway Enc.
Date "t ' "r d Owner
Infrastructure
Fringo-wea Mara MIS
'WORKERS' COMPENSATION DECLARATION
I hereby affirm'that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) s ,
Policy No. Company
• ❑ Copy is'filed with the city. ❑ Certified copy is hereby furnished.
v} TOTAL 52 Olt,) 0.6-1
n CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE C Iy AO -"X$ n
(This section need not be completed if the permit is for one hundred dollars ($100) valuation �''+ ,t`;tN. •Sixr r R% �-�%. . AO-"p%„as �•'"� �•�')
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If,. after making this Certificate of Exemption you should become ZONE: BY: '
subjectto the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
f CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I, hereby affirm that thereisa construction lending agency for the performance of the
'work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
, Lender's'• Name ,
�Lender's 11Address FINAL DATE INSPECTOR
This is a building peimit when properly filled out, signed and validated, and is subject to� �$ ,
expiration It work thereunder is suspended for 180 days.
I certify,that I have 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-
menlloned property for Inspection purposes. , Validated by:
Signature of applicant Date
Mailing Address. • Validation:
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY- FILE - -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT pr $
UNITS
COLL. AREA
tAB GRADE --'5 Ce�
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FTa
DUCT WORK
ROCK STORAGE
UND. REINF. % �7C� ���g�
/
POWER OUTLET
ROOF DRAINS
GAR SO. FT. fp
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO FT. (U
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
50. FT. rd
GRADING
cu. yd.
$ plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP. /'
WATER? WING
NOTE: Not to be used as property tax valuation
ROOFING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ILALJNDRYTRAY
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 t V. c
SEWAGE DISPOSAL
SO.FT.GAR Mic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
IAECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR GOND. SOLAR
SE-TBAQW
R D PLUMBING) ,7
UNDERGROUND
A.C. UNIT
COLL. AREA
tAB GRADE --'5 Ce�
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
UND. REINF. % �7C� ���g�
/
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. /'
RAMING % 2/
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR-
GA FIREWALL
M SH
NSULATION/SOUND
c` -
FINISH GRADING
FINAL INSPECTION ']J / QA -r'
o L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL