05436 (SFD)1`6
4 P. BOX 1504
No. 43 ,
Building
Address4--309 S�U B� LA QUINTA, CALIFORNIACAL FORNIA 92253
_
Owner SUIRME C ,ANY
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 42-600 Cha. Sn .200 � A.P. Number -
City Zip Tel. �iCALLMIR$
PAW ��$ 92260rQ 8-3$,� Legal Description
Contractor. Project Description IG3 A PMSE IR
Address
SAM
City Zip Tela
State Lic.
City
& Classif.
Arch., Engr.,
Designer
Address
Tel.
$}
Lic. it Sq. Ft. • - No: - - No--Dw.
Size 3$$1
City I Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby, affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7(100) of Division 3 of the Business and Professions Code, and my license is in full force and'
I
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busfness and Professions Code: Any city or county which requires a
permit to construct, after, 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 civilpenally of not more than Ove 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 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,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is said 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.)
❑ 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.)
❑ 1 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. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
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.)
1 certify that in the performance of thg work for which this•permit is issued; 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California-
Date
alifornia
Date Owner
NOTICE TO APPLICANT. Il, 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
Lenders 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 certity that I have read this application and state that the above information is correct.
i
1 agree'to comply with all city and county ordinances and state laws relating o 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
Stories - Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 272,603
.PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. 11010.�e
Const. 1,245.00
Mech. $ 2.30
Electrical 200 .45
Plumbing 19$.50
S.M.I. 19.11
Grading
Driveway Enc.
Infrastructure 6:6000.00
Lass fted:U
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
3/3189_
Issued by: Date
Permit
Validated by:
Validation:
i8
,t�ul�. O
TOTAL
REMARKS
�r�Y.t � i.4.J'S�.s •it '�.�-t��Y � %?%2J -orf cT ''.'".:` :.s'P w Yiti .l. a.�
Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
LAB GRADE S
ROU H PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
00,
FORMS
R SEPTI
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
S (ROUGH) /zi
/
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. Fi.
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
SQ FT a
AMING I Aye C6
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
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
SPARK ARRESTOR
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
SULATION/SOUND
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/.c
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
SET ACK
OUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE S
ROU H PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
00,
FORMS
R SEPTI
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
S (ROUGH) /zi
/
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
AMING I Aye C6
FINAL INSP.
ING
REMARKS:
VENTILATION
FIRE ZONE ROOFING'
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
7I N % % -,z
i
MESH
SULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL