04185 (SATT)4�
P.O. BOX 1504
Building78-105 CALLE ESTADO
Address 78-3717 .; � Cotte C'. i, LA•QUINTA, CALIFORNIA 92253
Owner r
BUILDING:, TYPE CONST. OCC. GRP.'
Mailing -
Address •777 S. Hain St. �. Suite Jot »... ... A: P: Number 613�����"���
• CityZip Tel. `
Orange 92696 1 714,-�g41-t GSA Legal Description
Contractor .lidiner 11 Plan 2' -
Same,
Address
City Zip Tel.
State Lic. City
&.Classif: - A62814 'Lic. # Sq. Ft.�1,2 No. No: Dvr.
Size Stories Units
Arch:Engr.; New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
;Designer''
'Adtir`ess° Tel. Oarage i3'1C'.`lud t
City; Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION a
I hereby affirm that I am licensed -under provisions of Chapter 9 (commencing with Section 'r
r
' 7000) of Division 3 of the Business and Professions Code; and my license is in full force and '
effect..
SIGNATURE - - DATE -
•
OWNER -BUILDER DECLARATION Estimated Valuation
• • I hereby affirm that I am exempt from the Contractor's License Law for the following 1er�•r'L� --
reason: (Sec. 7031.5,Buslness and Professions Code: Any city or county which requires a SFX -
permit to construct, after, 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 PERMIT ' ' ' AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or _
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. - qt,, c
subjects the applicant to a civil penalty of not more than five hundred dollars (8500). Plan Chk. Bal. 2 f b ..6 A
O I, as owner of the property, or my employees with wages as their sole compensation, will .
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 331#00
Professions Code: The Contractor's License Law does not apply to an owner or property who s,�
builds or improves thereon and who does such work himself or through his own employees,' _ Mech. �i�gyFlr
provided that such improvements are not intended or offered for sale. If, however, the building 44,76 ,
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical
of proving that he did not build or improve for the purpose of sale.) -
O I; as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 75..00
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. 1. {'• 41,59
such projects with a contractor(s). licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec. B. & P.C. for this reason Grading ,
Driveway Enc.
Date owner Infrastructure lt467.57
WORKERS' COMPENSATION DECLARATION
I hereby affirm that l 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 —'
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTALA7u ,..:
CERTIFICATE OF EXEMPTION FROM REMARKS 4
WORKERS' COMPENSATION INSURANCE
This section need not be completed if the t
( p permit is for one hundred dollars ($100) valuation €f,t .,, # � g� (:tqy •'h'�� �0• ;? �Y p. �•
or less.) - - � -
1 certify that in the performance of the work for which this permit is issued, I shall not
employ any peon in any manner so as to become subject to the Workers' Compensation
Laws of
Cal ifornirsa.
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 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 Address ., '. ;r
This is a building -permit when properly filled out, signed and validated, and is subject to ~ FINAL DATE dINrSPECT�sO�RR
expiration if work thereunder is suspended for 180 days.
I certify that l have read this application and state that the above informatidn is correct. Issued by: Date Permit
I agree to
. comply with all city and county ordinances and state laws relating to building ,
construction,.and heieby.authorize representatives of this city to enter the above
mentioned property for inspection purposes. . Validated by:
Signature of applicant
Mailing Address Validation: '
' City, State, Zip t
1
WHITE FINANCE PINK - APPLICANT, GREEN =BUILDING; GOLDENROD ASSESSOR S OFFICE HARD COPY. -FILE if °
.( i..: - .`. �' Yx'. 14%.-. ,i...�, ..1'1.,. ... �... 3R-S••.:.n. ....5 _. .. .at'"l,-.+ .. ._ ..'.rS. .:.t-vr :...__,. .+n 3. .. »w .� .3; _, .' •., r _.t i .w.. � i.`.!. ,vy - _ .... t. .a".- i._ -r•�r. ... � `w.1.,Y. '?.� - ~ ,.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO F1 rp $
UNITS
LAB GRADE 2 r-,.
ROUGH PLUMB
BONDING
SPKLR SYSTEM
2ND FL SO FT. itYARD
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. of
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. 0
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO FT. a
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. @
_ $
LUMBER GR.
FINAL INSP.
URINAL
SO. FT, rd
' ROOFING
ESTIMATED CONSTRUCTION VALUATION $
/
v—
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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, 0 c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 14: c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/� c
HOUSE SEWER
'
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE I.
DBL
TOTAL FEES
MICRO FEE
MECH.FEE I L.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACKOUND
PLUM
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE 2 r-,.
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
W14OUND. REINF./ 7,
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.
2--
FINAL INSP.
' ROOFING
////�
•//
/
v—
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR-
GAII. FIREWALL
MESH
ONISOUND�
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL