05434 (SFD)+ � _ ir, r �• cal •
P.O. BOX 1504 No. 05434
Building 78-105 CALLE ESTADO r
Address 54-23$ SOMMERN RMS LA QUINTA, CALIFORNIA 92253 I
Owner
Mailing
��V'I-�IY7E ��tSc-ii � r • Y • BUILDIGRP..
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NG: "TYPE CONST.' OCC: GRP:
Addres 42-600 COOK, STE 200
A.P. Numtiery
City, Zip Tel"-�.
PAM DER 922'6 } 568-,^428. Legal Description � •��� .
Contractor MT10kAL MUMS'
. r�uurc�a. SAM
, - - . , < t a
City Zip Tel::,
f State Lic. City 2� .
& Classif. Lic, #, .
.Arch., Engr-,
Designer
Address': Tel.
City Zip State
• - .. Lic. #
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
r effect fG.* f , -,K" -
SIGNATURETr- - DATE
OWNER -BUILDER DECLARATION
I 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, after. Improve, demolish, or repair any structure, prior to • its issuance also ,
T requires the applicant for such permit to tae a signed statement that he is licensed pursuant to -
the provisions of the Contactors License taw, 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
'r' ` • subjects the applicant to a cr4 pernany of not more than five hundred dollars ($500). '
❑ 1 as owner of the property or my employees with wages as their sole compensation will
Project Description M3 DR " PEM 1
SFD
r
Sq. Ft- 3831 ' No. p
-Size • Stories
New ❑ Add'❑ Alter ❑ -
stimated Valuation 232,603
PERMIT
Plan Chk. Dep.
Plan.Chk. Bal.
No. Dw..
Units
Repair.❑'Demolition ❑
kJ
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions
• Professions Code, The Contractors License taw does not apply to an owner or property who
Const.
� nn^^
� ,Ri245-011
Mech.
builds or approves thereon and who does such work himself or through his own employees;
provided that'such rrpiovements are not intended or offered for sale: If, however, the building
- •
,
- '
• or improvement is sok/ within one year of completion, the owner-bugder will have the burden
of proving that he did not build or improve lor.the purpose of sale.) ..
Plumbing.
' ❑ 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 bunds or inproves thereon,'and who contracts for
r such projects with a contractors) licensed pursuant to the Contractor's License Law.)
• ❑ Lam exempt under Sec B- & P.C. for this reason
S.M.I..
Grading
'
Driveway Enc..
,
1•'.. }
Date Owner
Infrastructure13,000.001
.r
t,
1�
WORKERS' COMPENSATION DECLARATION
' I hereby affirm that I have a certificate of consent to self -insure, or a certificate of `
Workers Compensation Insurance, o1 a certified copy thereof- (Sec. 3800, Labor Code.)
11a ra We
a" y _71,
_
Policy No Company
❑ Copy is filed with the city- ❑ Certified copy is hereby furnished.
TOTALs„s
i.: stir
.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(this section need not be completed H the pertrut �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
REMARKS
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•I!ks• i5�:?a
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Date • Owner
• • NOTICE TO APPLICANT: ff. after • making this certificate of Exemption you should become
subject to the Workers' Compensation' provisiois of the; Labor Code, you must forthwith
comply with such provisions or this Permit shag be deemed revoked.
ZONE:
Minimum Setback
BY: '
Distances:,
Front Setback from Center Line ' a
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for performance of the
work for which this permit is issued- (Sec- 3097, CW Code.) , ,
-
Side Street Setback from'Center- Line `
Side Setback from. Property Line
Lenders Name
Lenders Address
FINAL DATE
-
Issued by: '
- '
" Validated- by:
INSPECTOR '
t f
/ d li -
Date Permit
". , f'
r I
This is a buildin it when property
g perm p perty filled but, signed and validated, is subject to”
expiration if work thereunder is suspended for 180 days- . • . 4 -' '
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 properly for inspection purposes r . T
Signature of applicant- Date'
Mailing Add"'
Validation:
City,. State, Zip
'
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
GRADE Z
RO H PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT.
STORAGE TANK
FORMS
EWER OR SE
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROCK STORAGE
UND. REINF. 44
ROUGH)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WALL SQ. FT.
DRINKING FOUNTAIN.
FINAL INSP.
URINAL
SQ. FT.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
y�
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® i4C
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
9XFJOUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE Z
RO H PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SE
C
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
UND. REINF. 44
ROUGH)
LAI
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.
ING
FINAL INSP.
O6FING r
y�/ice„/l/f
Cz
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
G FIREWALL
y�
ME H
SULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL