07741 (RPL)Building- -
• Address
Owner
SMI'
'Mailing
Address. Q�
City,....
24'14
P.O. BOX 1504 No. O T T 41
- --7&105 CALLE ESTADO
544§9 SoUthe'rn Hills LA QUINTA, CALIFORNIA 92253''
th
4
BUILDING: TYPE CONST. OCC: GRP.
S i' ~fie A.P. NumberPGAt
Zip Tel: _ .
Le al Descri tion
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City,-
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state: LIC:`
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Arch:; `Engr.;,
Designer ' .. .
Address; :.
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Thereby"affi[rri.that 1 a 0
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Zip
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Project Description P 31 Spa
-Tel.:
City-- ' ;I '
Lic.# .S Sq. Ft. No... No. Dw.
Size . Stories Units`
Tel.
` State '
S DECLARATION
sof Chapter 9 (coma
yCode; and my Icer
nein with Section
is i full force and
b1UNA1UMt'• -"•" - - / / UAIt
OWNER•BUILDER DECLARATION,i f ;.
l4r reby 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 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 rive hundred dollars .($500).
0:1, 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
Pro(essi6riv 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,
.piovldedthat'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-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor'sLicense Law
does, not apply to an owner of properly who builds or'improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O I am•exempt under Sec. B. & P.C. for this reason
Date Owner
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. 3900, Labor Code.)
Policy No. I Company
❑ Copy is filed with the city. .❑ Certified copy is hereby furnished:-
CERTIFICATE
urnished-CERTIFICATE OF EXEMPTION FROM -
WORKERS' COMPENSATION INSURANCE '
(This section- need- not be completed If the permit 'is for one hundred dollars ($100) 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: 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. '
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's ,Address
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 certify that l have read this application and state.that the above information is correct.
1 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
City, State, Zip
.•t X'- -- .-.;.tc a.s .s: c t. ra . ,`gni ?T -•�'� w r'
New ❑ Add ❑
Alter ❑ Repair ❑' :Demolition ❑
TOTAL
REMARKS
t
."�iiV) RAO ?''`�#.,,•;� A''
^.
Estimated Valuation
$13AW I
PERMIT
r AMOUNT
Plan.Chk. Dep:
ZONE:
Plan Chk. Bal.
, • 93'
sow
Const. ' '
; 144'( j
Mech.0
"Q0
Electrical
Plumbing
S.M.I.
Side Street Setback from Center Line
Grading
Driveway Enc.
Infrastructure
INSPECTOR '
Issued by:
Date ermit
Validated by:
.. -. +.-. sF.'�'... j•, • -}tea 'f .V.�e nl.. . �'-. • •,'7'�`-• � •-,
TOTAL
REMARKS
t
."�iiV) RAO ?''`�#.,,•;� A''
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback.from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from•Property Line.
FINAL DATE
INSPECTOR '
Issued by:
Date ermit
Validated by:
Validation:
.. -. +.-. sF.'�'... j•, • -}tea 'f .V.�e nl.. . �'-. • •,'7'�`-• � •-,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SO. FT.
SLAB GRADE
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
ROUGH WIRING.
DRAINAGE PIPING
WALL SQ. FT.
ROCK STORAGE
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
HEATING (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
GAS (FINAL)
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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 ® 11/4 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'
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��'
/'1
C�<a
��
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