05992 (SFD)r
Building..
Address 54—%9.:iiut
Owner
. Surmise. Co.
Mailing
Address 73-005 Couzi
City. Zip
P.D. a
Contractor:
slaTar�,.
Address
' City Zip
State Lic.
City
8 ry Classif. 28��
Lic. #?Q
Sq. Ft. _
Size 272
N
, • o. No. Dw. .
_
"StorieS Units', -•
~Arch., Engr.; ,
4
• :.Designer; ? -'
4
Tel.
P.O. BOX 1504
N o ;
QQ
059-92'
78-105 CALLE ESTADO
City
Zip
LA QUINTA, CALIFORNIA 92253
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Lic. #
„
4
LICENSED CONTRACTOR'S DECLARATION
BUILDING: --TYPE CONST.•
OCC: GRP.-
club�
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PCA WaSt
;
Estimated . valuation
-
f i5S 646• ,00 ,
_
A,P. Number,
;y AMOUNT* • 'S
'
Plan Chk. Dep.
Tel.
Const.
f
-
Mech.
122
Legal Description
_
Electrical
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:rPlz
Plumbing
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ProjecYDescription se
•19B
10-M
Driveway Enc.
State Lic.
City
8 ry Classif. 28��
Lic. #?Q
Sq. Ft. _
Size 272
N
, • o. No. Dw. .
_
"StorieS Units', -•
~Arch., Engr.; ,
New [X . Add ❑. ,Alter ❑ Repair ❑..Demolition ❑
• :.Designer; ? -'
" `Address
.;,
Tel.
City
Zip
State ,
Lic. #
„
4
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section
7000Lof Division.3 of the Business and Professions Code, and my license is in full force.and
effect. T
_,
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-SIGNATURE DATE
" OWNEWBUILDERDECLARATION
I hereby affirm that I am exempt from the Contractors License .Law for the following
reason: (Sec. 7031.5,Bushess and Professions Code: Any city or county which requires a
Estimated . valuation
-
f i5S 646• ,00 ,
permit to constnicl, after, improve, demolish, or repair any structure, prior to its issuance also
• requires the applicant for such permit to Me a signed statement that -he is licensed pursuant.to
the provisions of the Contractors License Law, Chapter.9 (commencing with Section 7000) of
' 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 fora permit
subjects the applicant to a civil penally 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 Contractors License Law does not apply to an owner of property who •.
•PERMIT
;y AMOUNT* • 'S
'
Plan Chk. Dep.
Plan Chk. Bal.
Const.
f
-
Mech.
.builds or improves. thereon and who does such work himself or through his own I employees,
.provided that'such hmprovemems are not &fended or offered for sate. If,. however, the building
Electrical
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'
of improvement is sold wiMh one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sate.)
_ O I, as owner. of the propertyi am exclusively contracting with licensed contractors to con-
' struct the proect (Sec. 7044, Bushes and Professions Code: The Contractor's License Law
does not apply to an owner of property who budds or improves thereon, and who contracts for
'. •. 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 '
Plumbing
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S•M.1.
_
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Grading
Driveway Enc.
Date• Owner
Infrastructure
3569.53 J
Lew C_80t:.11114.11
' WORKERS COMPENSATION DECLARATION
I hereby affirm that 1 have i certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
rnfra Due-
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Policy No- Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished._
-
TOTAL
314309 / 2,& %.r' ye
CERTIFICATE OF EXEMPTION FROM'-
WORKERS' COMPENSATION INSURANCE •`
1'(This
REMARKS
.. _ � -. w -
section need not be completed if the permit is for one hundred dollars (S 700) valuation
. or 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
..
Date Owner
' NOTICE TO APPLICANT: Q after making this. Certificate of Exemption you should become •
subject to the .Workers' Carmpensatkv provsiorns of the Labor Code, you.must forthwith
comply with such Provisions orthis Permit shall bedeemed revoked. -
ZONE:
Minimum Setback
BY:
- 1 -
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 perrnit.)s issued. (Sec. 3097, ala coda.) i,
Lenders Name
-FINAL DATE,
by:
Validated by:
Side Street Setback from Center Line
, -
Side Setback from Property Line ,
, w
4 -
INSPECTOR .
Date Permit". '
".
• .• Lenders Address
This is a building permit when properly filled but, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.,
I certity that I have read this application and state that the above information is correct.ISSUed
' 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•. r
mentioned property for inspection purposes
Signature of applicant Date
s,
,Mailing Address
Validation:
City,. State, Zip
_ ..
.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
/ GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL Sp. FT. ®
F RMS
/
SEWER OR SEPTI AI
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SD. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SD. FT.
LU ER GR.
FINAL INSY-�'-fo
MING/ V
URINAL
Sp FT ®
D (�/amu
C(/Z/�JJ
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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.0001- HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAR. 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
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3l'ic
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
S ACK
OUND PLUMBING ? /
UNDERGROUND
A.C. UNIT
COLL. AREA
/ GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
F RMS
/
SEWER OR SEPTI AI
ROUGH WIRING
DUCT WORK
ROCK STORAGE
UND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEE
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ —Plus—x$—=$
LU ER GR.
FINAL INSY-�'-fo
MING/ V
FINAL INSP.
LNG /-4
D (�/amu
C(/Z/�JJ
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REMARKS:
iv_
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
Fil GSH
AE
ULATIONISOUND f(
v
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
'
GARDEN WALL FINAL
1