04187 (SATT)-Building
Address
Owner
Mailing
Address
City
Contractor
" Address .
Tit 44, 0 4 1,.� 7
P.O. BOX 1504 .
78-105 CALLE ESTADO
)0-3,9 , Irer'ra Cotta ifs 'LA QUINTA, CALIFORNIA 92253Boulevard Devalopm_nt
'
BUILDING: TYPE. CON STr OCC. GRP.
4 maid St., Suite 105 A.P. Number 61.3-790 -OT.XX + '
Zip Tel.
926$61 1714-547-805 Legal Description
Project Description B%Uldincr 12, Plan' 2
City Zip Tel.
State Lia City
• • & Classif. 4612814 Lic. # _ „ M, Sq. Ft.�
Size
Arch., Engr.,
Designer
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 full force and
effect. ,! •-•
SIGNATURE - - - ` wL DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
No.
Stories
New ❑ Add ❑ Alter ❑
�"at�lg•F3ki'!63 �BAt"�:TJf�1�4�
t
No. Dw: '
Units
Repair ❑ Demolition ❑
Estimated Valuation Wo 225
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
' t
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
Any Section 7031.5 any 'for
Plan Chk. Dep.
}•'
for the alleged, exemption. violation of by applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
- -
O I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
e
.4)275 .161.
1.
' Professions Code: The Contractor's License Law does not apply to an owner or property who
builds or improves thereon and. who does such work himself or through his own employees,
Mech.
33 1 . O U '
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
36 .00
or proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
A �R
44 *;P X51
6
struct the project. (Sec. 7044, Business and Professions Code:, The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
S.M.I.
- �y ti
5 boo
- such projects with a contractor(s), licensed pursuant to` the Contractor's License Law.)
Grading
,$ '
❑ I am exempt under Sec. B. ti P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
y *g
*57
Fringe -Toed 1. Izaxid Ju 18
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.
TOTALa.ili"7„
CERTIFICATE OF EXEMPTION FROM
REMARKS
+ J
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuationt;i.#_",i's��"(',3'^'?*t"";jiJ•7'�"'a.'�iFf
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: ff, after making this Certificate of Exemption you should become
ZONE:
BY: `
subject to the Workers' Compensation provisions of the Labor Code, ,you must forthwithMinimum
Setback
Distances:
comply with such provisions or this permit shall be deemed revoked.
- -
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
FINAL DATE
`
IN)SPOR
EC/T
This is a building permit when properly filled out, signed and validated, and is subject to
' expiration if 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-
mentioned 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
1S1 FL SO Fl (p $
UNITS
ROUGH PLUMB BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SO FT. a
DUCT WORK
ROCK STORAGE
REINF./rJ _ /� —
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
004AEINF. STEEL/ q
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR SO. FT. 4t
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRAINAGE PIPING
CAR P. SO FT. 0
LUMBER GR.
FINAL INSP.
77
CnL Z�.
FINAL INSP.
DRINKING FOUNTAIN
WALL SO. FT. C
REMARKS:
URINAL
SO. FT. (d
ESTIMATED CONSTRUCTION VALUATION S
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.0OOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
MESH
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
CERT. OCC.
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
INSPECTOR'S SIGNATURESIINITIALS
SO.FT.GAR (g 3i c
HOUSE SEWER
GARDEN WALL FINAL
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 8 AIR COND. SOLAR
SETBACK
ND PLUMBING � Zjj UNDERGROUND
A.C. UNIT
COLL. AREA
"L B GRADE2L4
ROUGH PLUMB BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
REINF./rJ _ /� —
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
004AEINF. STEEL/ q
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ p1u5 z$
_ $
LUMBER GR.
FINAL INSP.
77
CnL Z�.
FINAL INSP.
OOFING/'�.
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
O
MESH
AULATIONISOUND2--07-1357
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL