002871 (3&4)Building 55.291 pkire tC�l�
Address
Owner
sum-im amamm
Mailing
Address 75-005 �jnt�rV Club ve
City I Zip ITel.
Contractor
iva't:: x l -Mo tgaip and L40M
Address.
City lZip ITel.
State Lic. City
& Classif. 7ARl140 Lic. #
Arch., Engr.,
Designer
Address I Tel
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City(Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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. r
r.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit 'to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions or the Contractor's License law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe 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 ($500).
O 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,Buisness 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. 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 improve for the purpose of sale.)
O 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) licensed pursuant to the Contractor's License Law.)
O 1 am -exempt under Sec. B. 8 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 No. Company
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes. r
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
No. 002871
(BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description
OCC. GRP.
k IW.= 14 B
PIM 10 CZ
Minimum Setback Distances:
Front Setback from Center Line
LIG 2272
Sq. Ft. m 5$Z
Size
No. No. Dw.
Stories - Units
New ig Add O
Alter ❑ Repair ❑ Demolition ❑
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 1 277- 7Permit
Validated by:
Validation:
Estimated Valuation
1W,646.00
PERMIT.
AMOUNT
Plan Chk. Dep. .
Plan Chk. Bal.
485.64
Const.
50.50
Mech.
55.Q0
Electrical
102.17
Plumbing
X2$.50
S.M.I.
ll.ifi
Grading
Driveway Enc.
Infrastructure
2,M.00
TOTAL
3.362.91
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 1 277- 7Permit
Validated by:
Validation:
A7ZU4
1 3U 336291 Cp
CONSTRUCTION ESTIMATE
NO. ELECTRICAL F '-
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
UNITS
COLL. AREA
!-4/&ftLAB GRADE
Lz
OUGH PLUMB. !L( y
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT. ®
(FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN
SO. FT. ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
/ G�G Q6� r-0 (ti K.tA/�
Y
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. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
!!eeLATHING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
�Z&NSULATION/SOUND J =�
FINISH GRADING
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FECE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
i'�ETBACK Z, I S I
OUND PLUM Bfr-/q/ p?
UNDERGROUND
A.C. UNIT
COLL. AREA
!-4/&ftLAB GRADE
Lz
OUGH PLUMB. !L( y
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPT TOUGH
WIRIN'11 /0-1 j
DUCT WORK
ROCK STORAGE
//
GAS(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL 2GAS
(FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
FINAL INSP.
/
/4eRAMING .� lGr�i
/v�
FINAL INSP.
OOFING [�— �1
c
/ G�G Q6� r-0 (ti K.tA/�
Y
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
!!eeLATHING
MESH
�Z&NSULATION/SOUND J =�
FINISH GRADING
�INAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL