05422 (SFD)414,
P.O. BOX 1504 N o . 05422
Building_ 7&105 CALLE ESTADO
Address 58-087 SOUTHEM A U LA QUINTA, CALIFORNIA 92253 '
Owner SMMISE C MY
Mailing ,. BUILDING: TYPE CONST.- 'OCC: GRP.
Address 412400 CWK SiRM, STE 200. -, .» __
A'P. Number -
CityZip Tel. =ZRISS
PALK ���s$Ili 92260— Legal Description
Contractor �- Project Description Q A MU 13
Address SFD
Tel.:
State Lic.I City
& Classif. 28013€) Lic. it 208.
rvcn., �ngr.,
Designer
Address Tel.
City( Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm•that I am licensed under provisions of Chapter 9 (commencing with Section.
7000) of bivision 3.of the Business and Professions Code, and my license is in full force and
effect
SIGNATURE DATE
OWNEWBUILDER DECLARATION
1 hereby affirin that I am exempt from the Contractor's License law for the following
reason: (Sec. 7031-5,6ls ness and Professions Code: Any city or county which requires a
permit to construct, alter, Improve, dernafish, or repair any structure, prior to its issuance also
requires the applicant for such pernuT to We a signed statement that he is licensed pursuant to
the provisions of the contractors 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 civilpenahy of not more than two hundred dollars ($500).
❑ 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 Canhaaaes 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 sale. 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 build or riprove for the purpose of sale.)
❑ I, 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 contractor(s) 8censed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
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.)
Policy NoCompany-
0 Copy is filed with the city- ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This sermon need not be completed g the permit is for one hundred dollars (S100) valuation
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 Califomia.
Date Owner
NOTICE TO APPLICANT: N, after making this Certificate of Exemption you should become
subiect to the Workers' Compensation provisiwns of the Labor Code, you must forthwith
campy with such provisions or this permit shall be deemed revoked. - '
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, Civil Code.) .
Lenders Name
Lender's Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration it 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 the above.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City,, State, Zip
Sq. Ft. 33$$ No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
929..16
Const.
1,143.51D
Mech.
81.$0
Electrical
184.,17
Plumbing
180.50.
S.M.I.
17.08
Grading
Date3/SJS9
Permit,
Driveway Enc.
Infrastructure
Validation:
MSS
£iA. out.
TOTAL
3,G E i.3 ' _'
REMARKS �(�yj� ��j }} g�:y :::T�� 9xgr gg�ttyy, C j
.P�.D5 i5,e`q-3•lb'?7 S/S•$ ti9r 3'r*''"Srf;s. i' A, r i a. '
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 b Y•
Date3/SJS9
Permit,
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
COLL, AREA
S B GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. S0. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN.
WALL SO. FT.
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SO. FT.
GRADING
CU. yd.
$ -Plus-X$-=$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
D �
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
IKITCHEN 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
TION/SOON4421
SO.FT.GAR ® Vic
HOUSE SEWER
FINISH GRADING
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
S B GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
A96w,ER OR SEPT
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
S(ROUGH)012-71%' C--
V
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP OLE
GROUT
WATER HEATER
RVICE 1` L
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ -Plus-X$-=$
L ER GR.
FINAL INSP.
F MING 7
FINAL INSP.
00 ING
D �
REMARKS:
rw VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
AR. FI EWALL`L
T ING it t
MES
TION/SOON4421
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURE-SRNfT1ALS
GARDEN WALL FINAL