05431 (SFD)_. P.O. BOX 1504 N O . 05431
- -
Building�-i1� 7&105 CALLE ESTADO-
Address = LA QUINTA,:CALIFORNIA 92253
Owner
SMSB CWit
Mailing ". BUILDING`. TYPE CONST. OCC: GRP.
Address 0-6m CWKI STT ido A.P. Number �
City - Zip Tel.
PAIN
IDBS 92260 �5 3-2ffi2 _ _ Legal Description
Contractor Project Description-. @3 A ID::
-•.
WI DNAL W4'TGAGE
State Lic:
& Classif.
Arch.; Engr.-,
Designer
Address- ..
City
0 of
.. , - - - ..i. r - I
Zip Tel..
City
288130 Lic. #
Tel.
Zip State
Lic. # '
r' LICENSED CONTRACTOR'S DECLARATION .
that I am licensed under provisions of Chapter 9,(com
3 of the Business and Professions Code, and my lice)
2B Sq. Ft:
Size .
New ❑
Section
rce and
SIGNATURE" DATE
OWNER -BUILDER DECLARATION a
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
3a3l No.
Stories
' Add ° ❑
No. Dw.
Units
Alter ❑ .. Repair ❑ - 4' Demolition O
Lstlmatea valuation 272,603
Permit to construct, atter, improve, demolish, or repair any'structure, prior to its issuance also
requires the applicant for such permit to tie 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 civil penalty of not more than rive hundred dollars (S500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
1' 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
PERMIT
IAMOUNT
- � '
_
Plan Chk. Dep.
it
Plan Chk. Bal.
_
s U • s
Const.
- '
Mech. _
•' '�i.�
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.,. d, however, the building
Electrical
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or improve for the purpose of sale.)
Plumbing o
_
I ' Fi • :2
- -
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
• - slruct 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.)
• O 1 am exempt under Sec B. & P.C. for this reason
S.M.I.
L
Grading
Driveway Enc.
Date Owner
Infrastructure
a€ '' -
US$ CRUIXT
Muuuwul
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.)
lbraa Buz.
TMO.00
t r
Policy No."' Company
0 Copy is filed with the city., ❑ Certified copy is hereby furnished.
TOTAL'
9` .t3s� �= rig i' .r...: V77
'
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 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 •
t -
ry�R�
s
h P �r,p'
^'! i'1 401 I) �"t,O—E257T `� a $iO
Date Owner `
NOTICE TO APPLICANT: M, after making Otis Certificate or Exemption you shouldbecomeZONE:'
subject to the Workers' Compensation provisions of the Labor Code,` you must forthwith
comply with such Provisions of this Permit shall be deemed revoked.
BY: _
y
Minimum Setback Distances: -
Front Setback from. Center Line
Rear Setback from Rear Prop. Line'~
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, CivaCode.)
A
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
-1t
Lender's Address
FINAL DATE
ISSUed by:
Validated by:
INSPECTOR
Date $`�h� Permits"
: c
`
' 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 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 theabove-.
mentioned property for inspection purposes. ..
Signature of applicant Date
Mailing Address •
Validation:
City, State, Zip
"
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
GRADEjye?4q-,9
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
ROCK STORAGE
F ND. REINF.
11�
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
OTHER APP.IEQUIP.
17/
INF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WALL Sp. FT.
WATER HEATER
DRINKING FOUNTAIN.
FINAL INSP.
URINAL
SO. FT.
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
ING q
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
I LAUNDRYTRAY
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. a c
BATH TUB
SQ. 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
r r
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
UND PLUMBING.
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADEjye?4q-,9
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
OR SEPTI T
ROUGH WIRING
DUCT WORK
ROCK STORAGE
F ND. REINF.
11�
kER
OUGH) �' ' 1152!METER
LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
17/
INF. STEEL
GAS (FINAL)
TE P. POLE
GROUT
WATER HEATER
ICE / 1h
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
"BER GR.
FINAL INSP.
ING q
FINAL INSP.
ING�/
0
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MSH /
SUtAT10NISOUND ��
r r
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1