003302 (PAT)- UW11V .
P.O. BOX 1504 N `o .
....003302
Building 78-105 CALLE ESTADO
Address 'M-290 Y ,; SMISET RIDGE - LA QUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: TYPE CONST. OCC: GRP:
Address P.O. BDX 2267
A.P.Number
City Zip 'ITel. " - •
City F Zxs�T. 0-2-261.. .345R3521: Leg al Description
Contractor Project Description P�Ib om
Address
' 'City' Zip - Tell'
State Lic. City
& Classif: .: Lic. # Sq. Ft., No. No. Dw.
Size Stories Units
- Arch., Engr., _ .. ... . .
Designer. New ❑ Add ❑ Alter O Repair ❑ Demolition ❑
Address Tel.
City Zip State _
Lic. #
LIQENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of'Chapter 9 (commencing with Section ' s
7000) of Division 3 of the Business and Professions Code; and my license is in full force and
effect..
KiGNATORE DATE-
OWNER-BUILDER
ATE OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec._ 7031, 5, Business, and Pro/essions Code:..Any, city or county which requires a 71q v .
'permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also - -
requires the applicant for such permit to filea signed..statement that he.'ls.licensed pursuant to PERMIT - - ' AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with•Section 7000) or.
• . Division 3 of the Business and Professions Code, or that. he is. exempt therefrom; and Ili& 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). - ' ^ - - -
❑ I, asowner of the property, or my employees with wages as their. sole compensation, will. Plan Chk. Bal..
do ifie work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and ey� c°
Professions Code: The Contractor's License Law does" not apply to an owner of property ,who Const.' s
00
builds; or improves thereon and who does such work himself or through his own employees, Mech.
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 • ° Electrical •' '
or 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
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.) .. -
❑ I am.exempt under Sec. - B. & P.C. for this reason. Grading
Driveway Enc.
Date f f � j;aOwner "-� f= Infrastructure
WORKERS' COMPENSATION DECLARATION
d'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. ❑ Certified copy'is hereby furnished.
TOTALj,l,K? .
CERTIFICATE OF EXEMPTION FROM...REMARKS
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) _ ... .. .. { LL i
- I certify that in the performance.of thg work for which this permit is issued, I shall not a+ viii} % 6" , iavr f+r+: •&. e v t s- , �•G
- employ any person In -any manner so as to become subject to the Workers%Compensation
Laws of California.
•"Date Owner
NOTICE TO APPLICANT: If, after making this Certificate or Exemption you should become ZONE: BY:
"subject to the Workers" Compensation provisions of the Labor Code, you must 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 Side`Steeet Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the' 7- - '
work for which this permit is issued. (Sec. 3097, Civil Code.) -Side Setback from, Property Line
Lender's Name
Lender's Address FINAL.DATE INSPECTOR
This'is'a building,permit'when properly filled out,.signed and validated, and i's subject to
expiration if work thereunder is suspended for 180 days. 1 1
I certify that I have read this application and state that 'lhe•above'information is *correct. ISSued'.by: Date 8/6/8-7 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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
FOR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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.
FRAMING
FINAL INSP.
ROOFING
C
�J()
U
J
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.'
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL