05978 (SFD)• , t
P.O. BOX 1504 No, 45978
Building 78-105 CALLE ESTADO
Address 54--621 Southern falls LA QUINTA, CALIFORNIA 92253
Owner '
SLna;r3.Se Co. ,
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 75-005 try Club � A.P..Number PMA6 WeSt
CityZip Tel. -
922 568-28328 Legal Description
Contractor Project Description Phase 19B Plan 30DIR
Sam
Address .,
City Zip Tel:
State Lic. City
& Classif. 288130 Lic. # 328 Sq. Ft. 282f3 No. No. Dw.
�L��h:; Engr„
Size Stories - Units
Designer Newel Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
).hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7001) of.Division 3 of the Business and Professions Code, and my license is in full force and
_. effect..
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation !
I hereby affirm that I am exempt from the Contractors License Law for the following ��4lV�.
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
0-0
permit to construct, 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 PERMIT AMOUNT
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professiorns 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 Plan Chk. Dep. '
subjects the applicant to a civilpenalty of not more than fire hundred dollars ($500).P02.22- -
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Cont. 97
Professions Code: The Contractor's License Law does not apply to an owner of property who by
builds or improves thereon and who does such work himself or through his own employees, Mech. '>;?2• SE#
provided that such hyprovements 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 2
of proving that he,did not build or ' I
P 9 mprove for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to com. Plumbing 204.00
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. t3.;65
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under;Sec B. 8 P -C. for this reason
Driveway Enc.
Date Owner Infrastructure 4380. 5
Less G 8 l.£ 2190.29
WORKERS' COMPENSATION DECLARATION DuQ
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 '
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL'`/1* 16Y
CERTIFICATE OF EXEMPTION FROM REMARKS ,-„ _ ;,.,,.,._,
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation , i :;4,3 06 ^ w ,7'Gy 4 Yi) r' +.r g„<w. a� w �,.:.+ r • �.i F.t x -
or less:)
1 certify that in the performance of the work for which this permit is issued, I shall not
employ any pperson in any manner so as to become subject to the Workers' Compensation
Laws of Calrfornia
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
complywith such provisions or this pemtit shag 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
Lenders Name
Lenders Address FINAL DATE INSPECTOR
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 certity that I have read this application and state that the above information is correct. Issued by: Date 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. ated by:
Signature of applicant Date
Mailing Address Vali n:
City, State, Zip
I
W + CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
LAB GRADE
RO GH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
F RMS
EWER OR SE N /
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
OUGH) U
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
I
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
LUMBER GR.
AL INSP. r"
FRAMING /CZ
URINAL
SQ 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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
i
FINISH GRADING
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/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 42 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE
RO GH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
F RMS
EWER OR SE N /
ROUGH WIRING
DUCT WORK
ROCK STORAGE
i • UND. REINF.
OUGH) U
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
f Or REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
AL INSP. r"
FRAMING /CZ
FINAL INSP.
0-(OOFING /
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
WUSULATIONISOUND
i
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL