04189 (SATT)P.O. BOX 1504 '
04189
Building • 78-105 CALLE ESTADO
' Address 79-307 Terra Cotte Ct r LA QUINTA, CALIFORNIA 92253.
Owner v
BUILDING: -TYPE CONST. OCC. GRP.
Address. 777 S. > • ♦ 63 ` �;`0?
613-790-002
. . ,...
A.P�Number
City
Zip
Tel.
Orange
9268 ra
7� D 6
,Project
Legal Description = '•
•
tiiii'�in' ` 2 Pl it I2 �+.
Contractor
Sale
Description a
Address
City
Zip
Tel.
State Lic. 81
City
& Classjf.
Lic. If e - w
So. Ftp' No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer
New O Add O Alter 0 Repair 0 Demolition.0
` Address
Tel.
s
,
City -
Zip
State
•
Lic. If
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
i 7000) of Division 3 of the Business and Professions Code, and my license is in full force and
^
•
SIGNATURE - - ' ' t'- , - DATE
r
' OWNER -BUILDER DECLARATION
-
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
�9
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a .
. .225
- 2C
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 Any Section 7031.5 for
plan Chk. De p
the alleged exemption. violation of by any applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
K Plan Chk. BBI. - 7 • �+� .� 0 6
0 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. 3 1 11 lot
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. - Sib ib • V' U
provided that such Improvements are not intended or offered for sale. If, however, the building
orimprovement is sold within one year of completion, the owner -builder will have the burden
Electrical 44.76
of proving that he did not build or improve for the purpose of sale.)
0 I, as owner of the property, am exclusively contracting with licensed contractors to con-
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Plumbing Yi 5 w 00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does to who builds improves thereon, who for
R �y ,
S:M.I. • 4 59
not apply an owner of property or and contracts
such projects with a contractor(s) licensed pursuant tothe Contractor's License Law.)
- •. a
_
Grading
O I am exempt under Sec. _-B. & P.C. for this reason '
Driveway Enc.
Date owner
Infrastructure 11467 s7
Fringeilve fir: Mar'C''a ► a
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
' 0 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL�`��.o
CERTIFICATE OF EXEMPTION FROM
REMARKS 1
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is ,for one hundred dollars ($100) valuation
�. ".�yt.i-a: f,(:..5: :C: «+'1•v%fV row•.{i).J'] �'£y,
or less.)
-
I certify that in the performance of'thp 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. U, after making this Certificate of Exemption you should become
ZONE: BY: -
subject to the, Workers' �Compensalion provisions of the Labor Code, you must forthwith .
comply with such provisions or this permit shall be deemed revoked. r
_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
This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE INSPECTOR
>� ,
expiration if work thereunder is suspended for 180 days. 4 _
// 7 ,
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 g city' to enter the above.
t' "
,
mentioned properly for inspection purposes. i ^
Validated by:
Signature of applicant Date
,
Mailing Address
Validation:
City, State,' Zip
•;q
i WHITE - FINANCE, PINK APPLICANT, GREEN - BUILDING, GOLDE= A
NROD SSESSORS OFFICE, HARD COPY - FILE• A
._, *_ta
,. .Je_ . \ is ::'.>.`#_✓"_..-
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IS7 FL SO Fl p s
UNITS
B GRADE),-? �(
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC -ANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OUTLET
ROOF DRAINS
GAR SO. FT. 0POWER
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. 0
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. (a
= $
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. a
OFING_5
f
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
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 @ 1'A c
SEWAGE DISPOSAL
FINAL INSPECTION
SO.FT.GAR (g Ai c
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
IvECH.FEE PL.CK.F:EE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
gb
UND PLUMBING/ 2�Z
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE),-? �(
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC -ANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUNO. REINF. �Zr/g-7S
(/
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
2
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
y plus x$
= $
LUMBER GR.
FINAL INSP.
AM NG 2 G ���`
FINAL INSP.
OFING_5
f
)�/ —
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
G R. FIREWALL
ING
MESH
TIONISOUNDZ'Z
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL