04198 (SATT)P.O. BOX 1504
~ Building 78-105 CALLE ESTADO
Address 76-437 T rra Cottact s „LA,QUINTA, CALIFORNIA 92253 T r
Owner
Sbulovard Devalo»mwnt BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 777 $ d'n St • # SU't* _ rr A;P. Number . i. wf Q2
• .City Zip Tel.
Orangle 92686 714—_ Legal Description
Contractor Project Description ASUIldiag 14v Plan 2
Sam
Address
City
Zip
Tel.
State 'Lic.�
& Classif.
City
Lic. # . _
S 4= Ft. .. $
No. .. : No.'Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑,
Address ' w
Tel.
i3arage inalLRded `
fi 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 r."# DATE
rn°
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 rile a signed statement that he is licensed pursuant to
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Estimated Valuation€!
# 225
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
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
- 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-
Plan' Chk. Bal.
►e 15
+� •I+ �+
Const.
.Mech.
.'i61 VU
Electrical
44,76
Plumbing
_
75 1,01Q.
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.
q�ta1
4 ia7
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
•
O 1 am exempt under Sec. B. & P.C. for this reason
-
Grading
Driveway Enc.
Date owner
Infrastructure
t
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. ❑ Certified copy is hereby furnished.
TOTALS#iL'.'r
%•• S:...�l
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one -hundred dollars ($100) valuation
> -• n
-77
p'µ `
:" Q 514 -io,�.�sc�..•.+g�'A.F���`�"�%•�.-' • .... 4�s.+
Or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any paon in any manner so as to become subject to the Workers' Compensation
Laws of Califorrsnia.
4'4r IL'y405V K :+4pr tfi.. & a;f.,I .y O'K � 't
-
- -
Date Owner .
NOTICE 'TO *APPLICANT., -If, after making this Certificate -of Exemption you should become
ZONE:
BY: '
subject to the Workers' Compensation provisions of the Labor. code. you must forthwith
comply with such provisions or this permit shall be deemed revoked. - -
Minimum Setback Distances:
Front Setback from Center Line;
Rear Setback from Rear Prop. Line
coNSTRucrfoN LENDING acENcr:
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, civil code.) '
I
Side Setback from Property Line
Lender's„ Name
Lender's Addresst
•This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. r : , , _ - •
I certify that I have read this application and state that the above information is correct.
• I agree to comply with all city and county ordinances and state laws relating to building ,
construction, and hereby authorize representatives of :this city to enter the above-
mentioned property for inspection purposes_. - • •
• Signature of applicant' - ' Date
- Mailing Address
FINAL DATE
Issued by:
Validated by:
r:
Validation:.
s INSPECTOR
Date - Permit
City, State, Zip
GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE -
t ....-'�a!'�>. Y!,: .......?tzM,,,,. �..1::�,_ �w_. .'a 7L �:i,•. _.c•.`$_.S!.i. ". r.-�'u .,.. �:.cyGYd,�
WHITE FINANCE PINK - APPLICANT, GREEN - BUILDING,
�...'4:j;rr, - _.t•.i.f'F:- -... :t ...- ..5,�-,..�, w.. .,,.. �:r.:'siE iyP.; .y ,�., n,_x.jtr ...t?�•'.�v-:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (a $
UNITS
LAB GRADE/a-2,-7 lO,�
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. g
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FTa
GAS (ROUGH)
METER LOOP
GAR SO. FT. QF
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO FT. g
GROUT
WATER HEATER
WALL SO. FT. td
FINAL INSP.
DRINKING FOUNTAIN
SO FT (a
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION S
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
ING %
[
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
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%/4 c
SEWAGE DISPOSAL
/�
LATIONISOUND3i -a
u
SO.FT.GAR (g 3/4c
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
FINAL INSPECTION
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
UND PLUMBIN %
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE/a-2,-7 lO,�
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
-I
ND. REINF. /YCl
v VVV
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
yd.
$ plus x$
_$
LU BER GR.
FINAL INSP. 14cu.
ING %
[
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
GAR. FIREWALL
TH G /
MESH
/�
LATIONISOUND3i -a
u
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL