04197 (SATT)i Building
Address
Owner
Mailing
Address ..
City
OX:'+3
Contractor
' Address
;
9
1 7`
• P.O. BOX 1504
—4
. g35 TerX4 Cotta Ct 0 78-105 CALLE ESTADO ,
LA QUINTA; CALIFORNIA 92253-
Boulevard
2253„Boulevard Development
BUILDING: TYPE CONST. , OCC. GRP.
777 S4, Main Sto.,r Suite Q06 > � A:P.,Number-
Zip Tel.
02686 714t_547-:4050 Legal Description
Project Description
I
State Lic.
�3�
& Classif.
Arch., Engr.,
• Designer
Address
iD I Tel.
City
Lic. #• ... b .. Sq. Ft-, a 9No. � No. Dw.
Size • , Stories Units
Tel.
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
racm included
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.,,r
!� _
.. SIGNATURE - DATE
OWNER -BUILDER DECLARATION r
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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 rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 '(commencing with Section 7000) of -
Estimated Valuation
+.yi,
M s M -
PERMIT'
, AMOUNT
plan Chk. De p -
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 .,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500)
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
A 275 19 x, .
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
orimprovement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
Mech.
- �Z.
Electrical,
„
Plumbing
IS - 00
❑ I, 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.
S•M,I,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Grading
•
Driveway Enc.
Date owner
Infrastructure
1,467.57i,_
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 acertified copy thereof. (Sec. 3800, Labor Code.)'
'
'
Policy No. Company
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL2ss%/
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars IS 100) valuation''-
Of less.)
I certify that in the performance of thg 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.
a
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
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
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
FINAL DATE
Issued by:
INSPECTOR
Date Permit
construction, and hereby authorize representatives of this city' to enter the above-
bovementioned property for inspection purposes:
mentioned
Validated by:
' Signature of applicant Date
.Mailing Address -
Validation:
'City, State, -Zip
GOLDENROD ASSESSOR'S OFFICE HARD COPY -FILE ;
. 3 - 1
- •..,5. •;. .. _. r.. .- �',... .e
-WHITE FINANCE PINK APPLICANT, GREEN BUILDING,
}. LS . .t
. �.". . - - . ..
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT rp $
UNITS
ROUGH PLUMB BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SO FT. a
DUCT WORK
ROCK STORAGE
D. REIN F L 1 ' i'r6 }
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
REINF. STEEL
GAS (FINAL) TEMP. POLE
GAR SO. FT. a
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SO FT. f6'
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
WALL SO. FT. @
LUMBER GR.
DRINKING FOUNTAIN
�+
AMING --�L
FINAL INSP.
URINAL
SO FT (4
REMARKS:
ESTIMATED CONSTRUCTION VALUATION S
VENTILATION
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(AUT0)(DISHI
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a 1'A c
SEWAGE DISPOSAL
SO.FT.GAR rg 3/.c
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 8 AIR COND. SOLAR
SETBACK
ROUND, PLUM BINGI,jWej-' UNDERGROUND
A.C. UNIT
COLL. AREA
RADE t/� �'
ROUGH PLUMB BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER ORSEPTICTANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
D. REIN F L 1 ' i'r6 }
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEOU1P.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
�+
AMING --�L
FINAL INSP.
ROOFING
A � /� �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
G FIREWALL
LATH %
MESH
ULATIONISOUNDS-
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL