04159 (SATT)041}
• P.O. BOX 1504" •
Building 78-105.CALLE ESTADO
Address Cotta' i LA:QUINTA, CALIFQRN,IA 92253
Owner
soulevaixd Development
Mailing o BUILDING:' TYPE CONST. OCC. GRP.
Address 777 Sr .M in St.. rte 196 A.P. Number- 623.790.001 '
City Zip Tel.. _ '
� @ 192686 714447-8056 Legal Description
Contractor Project Description _ 8'l1ilC incr 12. Plari I
Address .
City. Zip Tel.
State Lic. _ City
& Classif. 462014 Lic. # . � Sq. Ft.926 No. � No. Dw.
Arch., Engr.,
Size Stories Units
'
• ;Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
• ,. Address Tel.
Garaq,% included
i r
City . " Zip State
Lic. #
- LICENSED CONTRACTOR'S DECLARATION '
1 herebyy affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) gf.Divisior 3 of the Business and Professions Code, and my license is in full force and
.effect.D,�r'fir` .,�.�' i."';,rt"''`r.,•ry ;��.a� k ,r'`.�Y':.�'"`.: a�• �•;,c�=�
SIGNATURE DATE '
4
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I •am exempt from the Contractor's License law for the following I'
reason: (Sec. 7031.5,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 forsuchpermit 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 - -
Dfvision '3.ofither8usiness and Prolessions Code, or that. he fs exempt therefrom, and the basis
for-the�elleyeCsexemption. Any violation o/ Section 7031.5 Dy 'any applicant for a permit Plan Chk. Dep. '
subjects the applicantto a civil penalty of not more than five hundred dollars (5500). ,
O I; as ownerof'the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 70 04
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and - Const. j e�
Professions Code: The Contractor's License Law does not apply to an owner of property who -
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. It, however, the building lyr�
or improvement is sold within one year o/ completion, the owner -builder will have the burden Electrical R y
o/ proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
Strutt 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,j•
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading '
,0 1 am exempt under Sec: B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure •
Fringe T000
k
WORKERS' COMPENSATION DECLARATION
Ihereby 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
CERTIFICATE OF EXEMPTION FROM REMARKS
• WORKERS' COMPENSATION INSURANCE t
+(This section need not be completed if the permit is for one hundred dollars (8100) valuation nr lii Cho. �:�?�1t��'1 ..��+•• ��iY `.j.Yf A0
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 ZONE: - BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith - -
complywithsuchprovisionsorthispermitshallbedeemedrevoked. Minimum Setback Distances: - -_
Front Setback from Center Line -
` `
'Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY $Ida Street Setback from Centel Line
Ihereby affirm that there is a construction lending agency for the performance of the '
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback.from Property Line-
Lender's
ineLender's Name
Lender's Address `FINAL DATE INSP CTOR
This is a building permit when•properly filled out, signed and validated, and is subject to, e; X
expiration If work thereunder is suspended for 180 days. - 4 ;a! ! J w
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
I agree to. comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize 'representatives of this city to enter the above-
mentioned property for inspection purposes.. { Validated by:
Signature of applicant r Date
Mailing Address °' Validation: r
City, State, -Zip '
+ 1 WHITE FINANCE PINK APPLICANT GREEN BUILDING, GOLDENROD ASSESSORS OFFICE, HARD COPY - FILE
,YY t
*,PrlrA_N_i:r. -.. J.•.r.tii ,:d _. �, ...�,... t. T+. r:�".. �.. .,:x is .. �2i•,1:ti-F•.-.Z .': rs .. .f .y,«!•..�,.N :,: ,... x.F ... .•3.�s^• _,c': ;-,.. '+...�.. �!":..- '.b--�.-1ws, s' ".±:
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO FT (p S
UNITS
SLAB GRADE Z�
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO F1. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT at
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. C1
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. Q
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
DRINKING FOUNTAIN
WALL SO. FT. @
=$
LUMBER GR.
RAMING'7 Z�.�
ROOFING
URINAL
SO. FT. d
REMARKS:
ESTIMATED CONSTRUCTION VALUATION S
WATER PIPING
NOTE: Not to De used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISHI
APPLIANCE DRYER
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. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID C 1 V: c
SEWAGE DISPOSAL
CERT. OCC.
SO.FT.GAR @ 3V c
HOUSE SEWER
FENCE FINAL
GAS PIPING
PERMIT FEE
GARDEN WALL FINAL
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
1wECH.FEE bL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
UND PLUMBIN y Z-fz
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE Z�
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
OUND. REINF./-2 / — SC6
(
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP. ! /K
GRADING
cu. yd.
$ plus xE
=$
LUMBER GR.
RAMING'7 Z�.�
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
GAR. FIREWALL
MESH
INSULATIONISOUND Z 2
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL