04270 (SATT)_-------------------. ---- ----_
('14270
P.O.
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 70-413 Terra Cotta Ct. LA QUINTA, CALIFORNIA 92253
Owner
Sf ulava1 Development. T_.
Mailing -. .,
BUILDING: TYPE'CONST. OCC. GRP.
Address 777 S. Main Std r Suite 106 A.P. Number 613-790-002
' • City Zip Tel.
Orange 92686 171.4tIIii'�-80!J6 Legal Description M
Contractor
Project Des cription.F'.I3,.
Address Palm Royale - Plan 3 - Building ,13
M
City
Zip
Tel.
State Lic.
City
& Classif. 462814
Lic. #
Sq. Ft. 736
Size - >
No. No. Dw.
Stories 4,. Units
Arch., Engr., -
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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
effects
SIGNATURE 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
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
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Estimated Valuation
-
PERMIT
- AMOUNT
Division 3 o/ the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Dep.
Plan Chk. Bal.
Const.
.'��%
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
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,
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
. o/ proving that he, did not build or improve for the purpose of sale.)
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
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
Mech.
., . f U
Electrical
1 • '
Plumbing
00
,
S.M.I.
a fi
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
Ir _2T -0. '
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
O Copy is filed with the city. O Certified copy is hereby furnished.
'
TOTAL
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
:if'f�(,?, ,§,{:•,�Q_„�-•w±i{-- -„ ,,,j
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
1 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.
AV .i flogY ttJ rvia, x. -VA. vs
Date Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or thispermit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
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 Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE
S E R
TO TO
INS5EJ
I
Lender's Address
This is a building permit when properly filled out, signed and validated, aiid 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.
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.
Issued by:
Validated by:
Date Permit
Signature of applicant Data
Mailing Address
Validation:
GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES,
NO. PLUMBING FEES
iS1 FL SO F1 rp $
UNITS
COLL. AREA
B GRADE lZ Y2—4a;41
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. at
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
DUCT WORK
ROCK STORAGE
F EINF.j
(o
POWER OUTLET
ROOF DRAINS
GAR SO. FT. C1
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO FT. a
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. a
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. tp1
GRADING
Cu. yd.
$ plus x$
'
_$
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP./6 -/
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
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 1Y: c
SEWAGE DISPOSAL
SO.FT.GAR rg 3i c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE i'L.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
OUND PLUMBIN77-1 _Q1
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE lZ Y2—4a;41
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
F EINF.j
(o
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$
'
_$
LU ER GR.
FINAL INSP./6 -/
MING d
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
N
M H
SOLATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
,
GARDEN WALL FINAL