04186 (SATT)4,4Q
P.O. BOX 1504
Builn78-105 CALLE ESTADO
Add8issg .78-303 lrorra cotta LA QUINTA, CALIFORNIA 92253 x „
OwnerBbu
le'g'=4 v61*p' t - BUILDING:`TYPE CONST. OCC. GRP.
Mailing '
Address • 777 9. mainft,'. 9004to 1`04 A.P. Number
City Zip Tel.
92686 Legal Description `
Contractor Project Description M--� �� 2
Sam
Address
City Zip Tel.
'- State Lic. City
& Classif. Lic. # „,. Sq. Ft.. :. 912 No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑' Alter ❑ Repair ❑ Demolition ❑
Address " Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
' 1 hereby affirm that 1 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 full force and t
effect: *
SIGNATURE - DATE '
OWNER -BUILDER DECLARATION Estimated Valuation
g�y
I hereby affirm that I am exempt from the Contractor's License Law for the following} 6iEG
reason: (Sec. 7031.5,Susiness 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 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 penalty of not more than five hundred dollars (8500). - -
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec.' 7044, Buisness and Const.+
'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, .Mach. s.U0
provided that such improvements are not intended or offered for sale. If, however, the building ryr
.or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 444 p�
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- PlumbingN
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. I. T. 59
such projects with a contractor(s) licensed pursuant tothe Contractor's License Law.) -
11I am exempt under Sec. B. 8 P.C. Grading for this reason '
Driveway Enc.
Date owner Infrastructure i �=
WORKERS' COMPENSATION DECLARATION r Ca Nm
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
O Copy is filed with the city. ❑ Certified copy is hereby furnished. -
CERTIFICATE OF EXEMPTION FROM REMARKS s
WORKERS' COMPENSATION INSURANCE
This section need not be completed if the permit is for one hundred dollars (S 100) valuation•" e i ;•'� L" d.� i 39 = iy •-
( p �`� �••-.��i'i'�'- .�tr37 ftp "� • �'�'. 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
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 e 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 I"
Lender's, Name'
Lender's.AddressCTOR
This is a building permit when properly filled out, signed and validated, anFINAL DATE INSPECTOR
d is subject to SPE A��S
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 agreeto comply with all city and county ordinances and state laws relating to building
construction, and hereby,Iauthorize representatives sof this city to enter the above-
mentioned property for inspection purposes. ;Validated by: '
Signature of applicant' Date `
Mailing'Address • ` -Validation: '
City, -State, Zip
r7F
WHITE FINANCE PINK APPLICANT, GREEN -BUILDING, GOLDENROD ASSESSORS OFFICE,'HARD COPY -FILE
.:. u.� ._ �.f, ,n,, >:Yc....,. '-. i,_i�t-1.-�t,...V�,Zr:a ..Y�.YJn,. r"•=:i,:. 'i,t;`4: 5_'t..: •.. ti.i ..�''� :d. ..�-`^v...-.3 ..,YJ7!.-.'.'13. .. :t. _... - k.. .,. a.-. '}'x .v,\..........��,_a M"}v�:z -`i ,.s .".Y �!`1].� ,:�s__'f4:.:_. -:s.�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO F1 (a S
UNITS
LAB GRADE z
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO F1. a
STORAGE TANK
FORMS
SEWER OR SEPTIC -ANK
MOBILEHOME SVC.
BAR SINK
POR SO FTof
4_PIU-NO. REINF.] %�(�j�D
r( C/ vG(/AQ
GAS (ROUGH)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. I(t
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO FT. a
GROUT
WATER HEATER
SERVICE
DRINKING FOUNTAIN
WALL SO. FT. f7
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. (a
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
G
WATER PIPING
NOTE: Not to be used as property tax valuation
FING -
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(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
MESH
TIONISOUNDZ 2
SO. FT. g c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ I'A c
SEWAGE DISPOSAL
SO.FT.GAR r 3/:c
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
hiECH.FEE I L.CK.rEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
PLUMBINf�
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE z
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC -ANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
4_PIU-NO. REINF.] %�(�j�D
r( C/ vG(/AQ
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.
y —Plus—X$
= $
LUMBER GR.
FINAL INSP.
G
FINAL INSP.
FING -
TO-
S
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
GA FIREWALL
l�
MESH
TIONISOUNDZ 2
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL