04155 (SATT)04.P.O.- BOX 1504 `
Building78-105 CALLE ESTADO'
' Address 7€ -421 Tama . Cotwt i 4:oUrtv.. LA QUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: _TYPE CONST. OCC. GRP.
-
Address.- 777 S. _Main St, o ftito 106.: - A.P.,Number.. 613-790-002
City Zip Tel.
gran*e 92686 7 .� ,�7.. 0 Legal Description
Contractor Project Description 11ixndin,q 14 r Plan A
SAM
Address
City Zip - Tel.
State Lic. City
& Classif, ,;4'2814 Lic. #_ : _ „ Sq. Ft. V6 No. No. Dw.
Size Stories Units
Arch:;<En9r #"`
Designer:: sj�,5•,:;' New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition O
Address` "tom ' Tel.
riakston included
City Zip State '
Lic. # '
LICENSED CONTRACTOR'S DECLARATION i
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) 0f Division 3 of the Business and Professions Code, and my license is in full force and y y
s. efffeeot.,v t a r • l., .rr .::_:, 1 f.J.,S•''
SIGNATURE - "' is DATE
OWNER -BUILDER DECLARATION G
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation $66. 3
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a - V +'�. +
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 thathe 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 ($500). , r ,
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. KV
W.
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 Const. .' tins
builds or'improves thereon and who does such work himself or through his own employees,'' Mech. 4b • vii
provided that such improvements are not intended or offered for sale. If, however, the building - ,r
or improvement is sold *within one year of completion, the owner -builder will have the, burden Electrical 45.(44
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- Plumbing '75 # UU
struct.the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law n
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 4 d 66
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ..
r Grading ,
O lam exempt under Sec. B. 8 P.C. for this reason y
Driveway Enc. y
Date Owner IynffrgasLtrucctture p® gyp, eic 18 5-ul .
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. '
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE �� y� i7� ►t L aA 9p
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation ." t6l">;t%�..�t,yr.1+y;5,:if;+d+rlt :.eF�„l""�6�w;xh-.tt•�}
or less.) «.� ,�..w •., �• r o.,,.... .. »...
1 certify that in the performance of tha 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 APPLICANAPPLICANT:if, after making this Certificate of Exemption you should become , ZONE: ` M BY: _
subject to the Workers' Compensation provisions of the Labor Code, youmust forthwith Minimum 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 r 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 II)S•�P�ErC/TeyO[�R
expiration if work thereunder is suspended for 180 days. 6! a / ! a 13
I car tify,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. i ''Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
.r
' WHITE -FINANCE, PINK APPLICANT, GREEN -BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY -FILE
CONSTRUCTION ESTIMATE
NO.. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO FT (a $
UNITS
'LAB GRADE Z -2_
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. @
FORM
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. @
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. 1R
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. @
=$
LUMBER GR..-�
FINAL INSP.
RAMING
✓✓✓
URINAL
SO. F7. @
/_
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
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(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR'
LAUNDRY TRAY
AIR HANDLING UNIT CFM
2R. FIREWALL
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
FINISH GRADING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID @ 1 I c
SEWAGE DISPOSAL
SO.FT.GAR @ 44c
HOUSE SEWER
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 & AIR COND. SOLAR
SETBACK
UND PLUMBING/0—�O
UNDERGROUND
A.C. UNIT
COLL. AREA
'LAB GRADE Z -2_
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORM
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
- OTHER APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xS
=$
LUMBER GR..-�
FINAL INSP.
RAMING
✓✓✓
FINAL INSP.
ROOFING
/_
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
2R. FIREWALL
ING -�
VH
NSULATIONISOUND�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURF_SIINITIALS
GARDEN WALL FINAL