05435 (SFD)P.O. BOX 1504 r
Building. 78-105 CALLE ESTADO
Address 5 259'SSR HIU- S LA QUINTA, CALIFORNIA 92253.
Owner
S€YMSE CVAP"Y
Mailing BUILDING: TYPE CONST:
Address 42--WO.COOK3 STE 200
A.P. Number
lo: 05'435.
3
OCC: GRP.
1
City
Zip
Tel. -•
PQM DES
92260
Legal. Description
G3 A, PRASE 1E
Contractor.
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Project Description
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Address
s3YD
MAE
City
Zip
Tel.: ., • , .. , _
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f.
State Lic.
City
& Classif. • 28$.$3
Lic. # 208 � � -y;';`
Sq.. Ft.
' 3831 •
t, No.. • ,No. Dw. r
'
Size
Stories Units -
Arch.;'Engr.,
- Designer
New ❑ Add ❑ '; Alter ❑, Repair ❑ • ';Demolition ❑
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
- effect
SIGNATURE •- - - • DATE
1t'
' OWNER -BUILDER DECLARATION'
Estimated Valuation
1 hereby affirin,that I am exempt from the Contractor's License Law for the following
272,1603
reason: (Sec.. 7031.5,Busoress and Professions Code:. Any city or county which requires a
- M
,• , permit to construct, after. Improve, demolish, •or repair any structure, prior to its issuance also
- _
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
PERMIT
AMOUNT. +7r
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 Any Section 7031.5 by any for
Plan Chk. Dep.
- • : :• -•.
alleged exemption. violation of applicant a permit
• subjects the applicant to a civilpernady of not more than rive hundred dollars ($500).
'
Plan Chk..Bal.
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
s • 4
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
192450JU
• 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,'
-Meth.
'� •�
provided that'such Improvements are not intended or offered for sale. If, however, the building
^
orIrtprovement is sold within one year of completion, the owner -builder will have the burden
Electrical
of proving that he did not build or improve for the purpose of sale.)
' ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to coo-.
Plumbing
+
' struct the project -(Sec. 7044, Business and Professions Code: The Contractor's License Law
• �:
does not appy 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.)
S.M.I.
Grading
: .
_
Cl I am exempt under Sec B. & P.C. for this reason
Driveway Enc.
"
Date Owner
Infrastructure . _
m0 '
WORKERS' COMPENSATION DECLARATION
� °�
J j ;7u
I her 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
.
O Copy is filed with the city. ❑ Certified copy is. hereby furnished. ,
—
TOTAL
9•a a Eau, v, m .:y:; •1I s
CERTIFICATE OF EXEMPTION FROM>'
WORKERS' COMPENSATION INSURANCE -
REMARKS
- r d.a"±;rA,.s,t',�x;� 4�.�egt :tf91F^A f ; r6
(This section need not be completed if the permit is for one hundred dollars ($400) valuation`'
M w ss.xv sw x�,e+•awt sr�^ +. -" -r. r w•v -•
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
m =
Date Owner
NOTICE TO APPLICANT: B, after making this Certificate of Exemption you should become
ZONE:
BY: •'
sut4ect to the Workers' Compensation provisions. of 'the Labor Code, you must forthwith
comptywith such provisions orthis permit shall be deemed revoked.
-
Minimum Setback Distances:-
'
Front Setback from Center. Line "
J
Rear,Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
1 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 . '.
Lender's Name
Lenders Address
FINAL DATE
INSPECTOR
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
NS
I certify that I have read this application and. state that the above information is correct.
.-Issued by:
Date Permit
,Y 1 agree to comply with all city and county ordinances and state lawsrelating to building
construction, and hereby authorize representatives -of this city to enter the -above.^
mentioned property for inspection purposes.
'Validated by:
Signature of applicant Date
+ ,
Mailing.Address -
Validation:,
r °
City,. State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SO. FT.
DUCT WORK
ROCK STORAGE
UND. REINF.
MOB]LEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. Q
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRAINAGE PIPING
CAR P. SQ. FT. ®
LUMBER GR.
FINAL INSP.
MING
FINAL INSP.
DRINKING FOUNTAIN.
WALL SQ. FT.
REMARKS:
URINAL
SO FT ®
FIRE ZONE ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
SPARK ARRESTOR
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. 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
IVECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
BGRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SfYT5Tw ROUGH WIRING.
DUCT WORK
ROCK STORAGE
UND. 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.
MING
FINAL INSP.
OFING �'
/ , /, Q
®� /-' V
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GFIREWALL
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION-
NSPECTION
CERT. OCC.
CERT.
FENCE FINAL
INSPECTOR'S SIGNATURBSIINITIALS
GARDEN WALL FINAL