05991 (SFD)kc ,
Building • -
Address
Owner
Address, 73-003
City
.... P..D.
Contractor
same
Address.
,try club
Zip
92260
TAi!t
' P.O. BOX 1504 No. 059
78-105 CALLE ESTADO
"LA QUINTA, CALIFORNIA 92253-
BUILDING:
2253BUILDING: TYPE CONST. - OCC: GRP.
N A.P. Number M. West,
Tel. „
Legal Description
Project Description ' Ase' 19A Plan 10M
.,I+y
Tel...
_
State Lic.
City
+
I'
' 8 Classif..
• 288.130
Lic. #
328
Sq. Ft.
Size 222.-•
No. No. Dw:
DW`
Stories Units .:..
Arch., Engr:, "..
` .Designer-.
NewIlk Add ❑ Alter ❑ Repair.❑ A. -Demolition ❑
Address, ..• .
Tel.
'City"
..
Zip
State
Lic. #
77r iy
_
UCENSED CONTRACTOR'S DECLARATION '
I hereby affirm that 1 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.
V
SIGNATURE DATE
' OWNER -BUILDER DECLARATION ` '. '
1 hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5•Business and Professions Code: Any city or county which requires a
' 'permit, to,construct, site,, 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 -
the.provisions-•of the Contractor's 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 for a permit
' subjects the applicant to a civil penalty of not more than five hundred dollars .($500):
O I, as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation
'
1g 6.46.00
PERMIT,,
" `AMOUNT
. Plan Chk. -Dep.
-
Plan Chk. Bal.
° 70.27%'\• ~
�. ��-
do the work, and the structure is not intended or offered for sale. (Sec: 7044, Buisness andCpnSt.
• Professions Code: The Contractor's License Law does not -apply to an owner of property who
Mech.
���. - , a•
builds or improves thereon and who does such work himself or through his own employees,
provided Nat such improvements are not intended or offered for sale. It, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or improve for the purpose of sale.)
' ❑ 1, 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
Electrical
aa
Plumbing
S.M,I,
77
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
F p
O 1 am exempt under Sec. B. &-P.C. for this reason
Grading
Driveway Enc.
Y
Date owner
Infrastructure
3T69 .5 3
ideas iUxt
..
WORKERS' COMPENSATION DECLARATION
Infra Due
�.
• I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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.
-
. �? . ` -�+1,
M
TOTAL 374 a�''; x},'� . s
REMARKS
r :rt•s me 11 . t' %� ::n^^«?: r"i ,_t = .>.� htf
CERTIFICATE OF EXEMPTIONTROM
WORKERS' COMPENSATION INSURANCE
' (This section need not be completed if the pennd is for one hundred dollars ($100) valuation
.. or less.)
•
.J x.1'1xlS 1= 4•.i'.1'1`!'.�."'.i•��` "sr«-+w.z a -=•r - '
- - -
I certify that in the performance of the 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: It, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
\
ZONE: BY:
Minimum Setback Distances: - f t1 : •' ,
•
Front Setback.from Center,Line
Rear Setback from Rear Prop. Line - t
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
w
Side Street Setback from Center Line
c
Side Setback from Property Line
Lenders Name
FINAL DATE
Issued by:
Validated by:
INSPECTOR,
6-7 1.9789
Date 7 Permit -
t•
„
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to.
y 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
t ,construction, and hereby authorize representatives -of this city to enter the •above.
mentioned property for inspection purposes. - '
Signature of applicant Date'
Mailing Address
Validation:'
City,. State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
GRADE 15110
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
F07S',
R OR SEPTIC
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
I
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
_$
LUMBER GR.
INALINSP. �� �Of'
AMING C�
URINAL
SO. FT.
�
/ �/
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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
FINISH GRADING
SQ..FT. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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
UND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE 15110
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
F07S',
R OR SEPTIC
ROUGH WIRING
DUCT WORK
ROCK STORAGE
D. 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.
INALINSP. �� �Of'
AMING C�
FINAL INSP.
ING ��
�
/ �/
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
TIONISOUND,� /
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1