05432 (SFD)4
4
P.O. 4 No. 054
BOX 150
Building, . 7&105 CALLE ESTADO
Address 54-123 123 SOUTWN EMS LA QUINTA, CALIFORNIA 92253
Owner
SMMSE COMMY
Mailing
Address 424.00 COOK, STM 200
City . Zip
. PMA DESERT 92260
Contractor
MONS HORT-ftZE
Address
State Lic.
Alter ❑ Repair ❑
-Demolition ❑
& Classif.
I
Arch., Engr.,
Designer '
Address
Tel.
2�S13g
' - BUILDING: TYPE CONST. OCC: GRP:
Legal Description GALLERIES
Project Description ��' B�' ��+ 1
City
Lic. #
City lZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am lieensed,under provisions of Chapter 9 (commencing witt Section
7000) of Division 3 of the Business and Professions Code, and my license,is in full force and
effect
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirin that I am exempt from the Contractor's License Law for the following . .
reason: (Sec. 7031.5,8usi ess and Professions Code: Any city or county which requires a
permit to construct, alter, krprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Me 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 aged exemption- Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenalty of not more than five hundred dollars ($500).
Cl I, 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 Contractors 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 knprovements are not intended or offered for safe. 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 braid or improve for the purpose of sale.)
❑ 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 builds or improves thereon, and who contracts for
such projects with a cordrac(or(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
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 ff the pemuit is for one hundred dollars ($100) valuation
or less.) '
I 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 owner
- NOTICE TO APPLICANT. ff after making this Certificate of Exemption you should become
su#ecf to the workers' Compensation provisions of the Labor Code, you must forthwith
comply ri7h such Provsions 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.)
Lenders Name
Lender's Address
This is a'building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 certify that 1 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
Mailing Address
City, State, Zip
Si' -`D
Sq- - 3531 Stories Size . Stories
F' ,
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑
-Demolition ❑
Estimated Valuation
272,60-3
PERMIT
Validation:
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
1,, 010.30
Const.
l s 245'.00
Mech.
$1..5fl
Electrical
2(*.45
Plumbing
195..50
S.M.I.
19.11
Grading
Driveway Enc.
Infrastructure
6,000.00
INNS 'CRHD�133.00-9,000J
TOTAL
REMARKS
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 '-
Issued by: Date 3,3/99
Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SQ. FT. ® $
UNITS
GRADE
ROUGH PLUMB.
BONDING
SPKLR SYSTEM
2ND FL SQ. FT. @YARD
FORMS
S WER OR SEPTI
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH)
TGAS
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR, SQ. FT. ®
TE P. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
=$
L BER GR.
FINAL INSP.
ING
-A 1111 7A2'
URINAL
SD. FT.
�i
V '
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
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
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
G FIREWALL
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.
SQ. FT. ® c
BATH TUB
FINISH GRADING
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
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
S5rBACK
UND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
S WER OR SEPTI
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
aoeoUND. REINF.
ROUGH)
TGAS
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
(FINAL)
TE P. POLE
GROUT
WATER HEATER
RVICE I� 'Z
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
L BER GR.
FINAL INSP.
ING
-A 1111 7A2'
FINAL INSP.
OFING /
�i
V '
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
G FIREWALL
HI
MESH
ULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURE571NITIALS
GARDEN WALL FINAL