05424 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO '
Address -54'403 SOMEM Ei2I+LS 1 LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 4200 0= Sys
City Zip Te
, : PAIM IDES 92260
Contractor.
Address
SME
No. 0524
- BUILDING: •TYPE CONST. OCC: GRP.
STE 20 - A.P. Number \�
56 + Legal Description 4GALLEMS \1
Project Description Q
A� 1E >" `
..._. .., $WD �.
State Lic. 2€�T3
& Classif..
City
Lic. #
S Ft.
-size 3355
I•'"
No., , , No. Dw.
�f Stories Units '
Arch:, Engr.•,
Designer
New ❑ Add,O'. Alter ❑ Repair ❑ Demolitiori ❑
Address:'
Tel.
City '
Zip
State
ry
Lic: #
f LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I 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. .. ' w
�+
-
SIGNATURE - _ DATE
OWNER -BUILDER DECLARATIONEstimated
• I hereby affirm that 1 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
permft,to construct, after,,Improve, demofish, 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 (8500).'
❑ 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
Professions Code: The Contractor's.Ucense-Law does not apply to an owner of property who
Valuation,
243,165
.ti -
PERMIT =AMOUNT
'
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Plan Chk. Dep.'. - -
Plan Chk. Bal. • _
S + '
Const.114
Mech.
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builds or improves thereon and, who does such work himself or through his own employees,
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
of proving that he did not build or Unprove for the purpose of sale.) ..
Electrical
184M
Plumbing
_
+�
❑ 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's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
^ such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
• O 1 am exempt under Sec. B. & P.C. for this reason
$•M.1.
- -, i •
Grading
-
Driveway Enc.
Date owner
Infrastructure
5 14 •12
tESS CMIT8.'
a
WORKERS' COMPENSATION DECLARATION-
` '"I hereby affirm that I have a certificate of consent to self -insure, or acertificate of
' Worker's Compensation Insurance, or a certified copy thereof. (Sec. 380.0, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished: -
TOTAL
fit J a
REMARKS
CERTIFICATE OF EXEMPTION FROM
-WORKERS' COMPENSATION INSURANCE
(Tris section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
1 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: t, 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 orNispermit shall bedeemed revoked. - - -
- t
ZONE: _ ` BY:
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Minimum Setback 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 permit is issued. (Sec. 3097, Civil Code.) .
Side Street Setback from Center Line •
Side Setback from Property Line
Lender's Name
Lenders Address
FINAL DATE
INSPECTOR
s'
-.
//
'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 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
construction, and hereby authorize representatives -of this city to enter the -above.,
mentioned property for inspection purposes. -
'Signature of applicant ' Date'
•ISSUed by:,
Validated, by:
Date Permit
-
- x
„ h Mailing Address
`• Validation:
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to
City,,State, Zip
7
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
ROU PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SQ. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
NF. STEEL 5
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRAINAGE PIPING
CARP. SQ. FT. ®
LUMBER GR.
FINAL INSP.
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
/ 11
URINAL
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
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
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
FINAL INSPECTION-
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
INSPECTOR'S SIGNATURESIINRIALS
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 BACK
UND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE
ROU PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER R SEPTI ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GH) A2 METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
NF. STEEL 5
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FR ING
FINAL INSP.
FING f�
/ 11
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
G FIREWALL
ZPI G & Z2
MESH
SULATIONISOUND %/
FINISH GRADING
FINAL INSPECTION-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINRIALS
GARDEN WALL FINAL