05433 (SFD)P.O. BOX 1504 N o . 0543'
Building 78-105 CALLE ESTADO
Address e,473 SOUM LA.QUINTA,.CALIFORNIA 92253
Owner
i
iT$K d way
BUILDING:--TYPE-CONST. OCC: GRP. ;
Mailing
Address 42-400 COOK, STE -200
" A:P: Number- -
City Zip Tel:
NES z> DESS 92260 -568-2828., Legal Description i-ALLMES
0MME
Contractor r .
NATIONAL WMAGE Project Description 2' � � � ��
Address: f°.. SFS x
_SMM 57'
city
State Lic.
��
& Classif. .
Designer
Address'
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. ; . 'J ;' sr .r`.s. '.�'' ._r•:?'t'` �„_":� , � J , r L' ' ,✓'
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
City
Lic. #. 208
Sq. Ft. = No.
Size Stories
LNew ❑ . Add '❑ Alter ❑
No. Dw.
* Units
Repair 0`11- ., ' -Demolition ❑'
y .
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Bucounty which and Professions Code: Any city or. counwhich requires a
Estimated Valuation 272,603
i
._
PERMIT.
- •r,
AMOUNT
Pemdt to construct atter, mwfove, demolish, or repair any structure, prior to Its issuance also
requires the applicant for such permit to We a signed statement that he is licensed pursuant to
the.Druvisions 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
Plan Chk. Dep. -
-
` subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
., ❑ 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, Suisness 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. n however, the' building
or improvement is sold within one year of completion, the owner -balder will have the burden
of proving that he did not build or improve for the purpose of sale.)
•
plan Chk. Bal.
'� s•
Const.
Mech.
WORKERS' COMPENSATION DECLARATION
Electrical
S 1 a
Plumbing
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to coo-
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 bmproves thereon, and who contracts for
S.M,I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law)
Policy No,"Company
Grading '
[II am exempt under Sec B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
T '
S 1 a
'I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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.
TOTAL
>/3L6� •"e r1z-s..
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(this section need not be completed if the permit is for one hundred dollars ($100) valuation
f�s�''• h� s,�i
- . !f:•EY� 5MW P4-7. Ur •+53 . V trr i!A:c t`;t ,! V,
' or less.)
I certify that in the performance of the 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
r
Date Owner
NOTICE TO APPLICANT, ff, after making this Certificate of Exemption you should become
' ZONE:
BY: - -
Subject to 'the Workers' Compensation provisions of the -Labor' Code, you must forthwith
. comply with such Provisions or this permit shall be deemed revoked. =' -
Minimum Setback Distances: -Front
Setback Setback from Center Line"
..
Rear Setback from Rear Prop. Line .'
• CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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 Setback from Property Line
Lenders Name
Lenders Address
FINAL DATE
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 certify that 1'have read this application and state that the above information'is correct.
Issued by:'
Date ! r Permit.' -
1 agree to comply with all city and county ordinances and state laws relating to building
an
construction„ and hereby authorize representatives rof this city to enter the above-.
mentioned for inspection purposes. ;
Validated by:
Signature of applicant t Date'
'.Mailing Address
Validation:
City, State, Zip 1
�•�
F.
.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
RADE
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
ROUGH WIRING.
ER OR SEPfw
MOBILEHOME SVC.
BAR SINK
POR. SO. FT.
OUGH)j - METER LOOP
HEATING (FINAL)
POWER OUTLET
IROOF DRAINS
GAR. SO. FT. ®
GROUT
DRAINAGE PIPING
CAR P: SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT. @
-$
L MBER GR.
FINAL INSP.
AeAM G
URINAL
SO. FT.
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ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE7�-S�
ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBING jZ 7 UNDERGROUND
A.C. UNIT
COLL, AREA
RADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ROUGH WIRING.
ER OR SEPfw
DUCT WORK
ROCK STORAGE
UND. REINF.
11-46
OUGH)j - METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
11
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
-$
L MBER GR.
FINAL INSP.
AeAM G
FINAL INSP.
OOFING
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
I EVOACL
LATHING
MESH11 1
�LATIONISOUND/SOUND `
FINISH GRADING
FINAL INSPECTION/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL