05416 (SFD)Wy/4, 416
P.O. BOX 1504 N o . 0S
Building: r 7&105 CALLE ESTADO
Address 54-7,03 .SaOUTMN RULS w , LA,QUINTA, CALIFORNIA 92253
Owner . SM2SE MAPS T
Mailing BUILDING: TYPE.CONST. OCC: GRP.
Address 42--600 COOK 5T 'T4 STE- d200
A.P. Number
City. Zip JTeli,... . - • • -
AZ. 33E�E '92260 b
w Legal Description G3 BR i
Contractor;Project Description PHASE IE• M
RATIOR L KMOACE _
Address
- -City .
Zip
Tel.:,
State Lic. _ _
& Classif.` 28$14i
.'Arch.,
City
Lic. # . » 20S.,
Sq. Ft. 30
Size
No. No. Dw. -
Stories } - Units -
Engr.,
-: Designer
New.❑ Add ❑
Alter ❑: • Repair O " Demolition ❑
Address-,
Tel.
' CityM.
Zip
State
.,
-
Lic. #
t
LICENSED CONTRACTOR'S DECLARATIONf.
I hereby affirm that 1 am licensed under Provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the'Btisiness and Professions Code, and my -license is WWII force and
effect> �r . Cq if (` i ,r J r �' f.- 1.•� i"
" •
SIGNATURE - DATE
OWNEWBUILDER DECLARATION
1 hereby affftm that 1 am exempt from the Contractors License Law for the following
reason: -(Sec.• 7031.5,B,tiress and Professions Code: Any city or county which requires a
Estimated Valuation
f
242,43 -'
PERMIT
-- - - -
AMOUNT
a
- Permit to censbrmct. ager, irprove, 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 provsiorms of the Conbactorls License Law, Chapter 9 (commencing with Section 7000) of
• LAvisfon 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
_ for Me alleged exemption Any.viollation of Section 7031.5 by 'any applicant for a permit
Plan Chk. Dep. `
- - -
-
subjects the applicant to a crv9 penally, of not more than two hundred dollars ($500). •
` ❑ 1, as owner of the property, or my employees with wages as their sole.compensation, will
Plan Chk. Bal.
Const.
8 �'
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code. The Contrddars License Law does not apply to an owner of property who
' bu>7ds or improves thereon and who does such work himself or through his own employees, •
,.provided Mal; such improve maenls are not intended or offered for sale. If, however, the building
Mech.
•'
.
Electrical
or crprovernent is sold within one year of completion, the owner -builder will have the burden
. of proving Mat he did not buil or improve for the purpose of sale.) _.
Plumbing�ns
3i
11•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'owrw of property who builds or improves thereon, and who contracts for
S.M.I.such
projects w7M a conVactmr(s) licensed pursuant.to the Contractor's License Law.) -
fit 1 am exempt under Sem R. & P.C. for this reason
Grading
-
Driveway Enc.
Date owner
Infrastructure
LAWS Cxe
• WORKERS' COMPENSATIOWDECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, of 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. ' D Certified copy is hereby furnished.
TOTAL
s" to +a5 ij ]� i_•-5 7)
REMARKS"
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
' (n+ls section need not De oonpkted if the Permit is for one hun
... .. .. .. -
or less.) dollars ($100) valuation
certify that in the perfomtance of thg work for which this permit is issued, I shall not ^
"employ any ppeerson in any manner so as to become subject to the Workers' Compensation'
laws of Cahf�Jrttia 1.
1")x --$}?t My/ ,L- �.x`tri v'aS�- ?°73 '�:T " -.41.f
-
Date Owner
~BY:-
Y
N077CE TO APPLICARR C, after this Certi/fcate of Exemption
making p you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such prov&omorthisPermit shall bedeemed revoked.
ZONE: - -
Minimum Setback Distances: '• -
Front Setback from Center Line
Rear Setback from Rear Prop: Line '
CONSTRUCTION LENDING AGENCY -
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issues. (Sec. 3097, Civil Code.) •
•
Side Street Setback from Center Line -
Side Setback from -Property Line.
r Lender's Name
Lenders Address
FINAL DATE
Issued by:
`
Validated by:
INSPECTOR
-
3/3189
Date / Permit''
ry
This is abuilding permit when property filled out; signed and validated, and is subject to
' expiration it work thereunder is suspended for 180 days:
1 certify that 1 have read this application and state that-the;above.information is correct. a
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 AdQress - -
.Validation:-
-- - •- - - -
City,. State, Zip
1 CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
DUCT WORK
ROCK STORAGE
UND. REINF.L.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT.
AfREINF. STEEL
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRAINAGE PIPING
CARP. SO. FT. ®
LUMBER GR.
FINAL INSP.
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
vS�
l L1
URINAL
SQ. FT.
ESTIMATED CONSTRUCTION VALUATION $
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
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.
SQ. FT. ® c
BATH TUB
FINAL INSPECTION
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FENCE FINAL
SQ.FT.GAR ® V4c
HOUSE SEWER
INSPECTOR'S SIGNATURESIINITIALS
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 S AIR COND. SOLAR
S51FBACK
ROUND PLUMBING- 3 UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE ?j�
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SEP ROUGH WIRING
DUCT WORK
ROCK STORAGE
UND. REINF.L.
(ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
AfREINF. 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.
OOFING
vS�
l L1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GA! FIREWALL
ING L�
MESH
NSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1