002859 (3&4)Building 55-405 p�LXjStCM
Address
Owner
ram �Y
mailing
Address 75-005 00tu1t
City Zip
Contractor
Address.
F I r
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 002859
BUILDING: TYPE CONST: OCC. GRP. -
lub 'Vivi? A.P. Number
Tel.
60 Legal Description
Project Description 11M wpm 112=7 14 H
att.r� T rim 40 C!
City .. .,
Zip
Tela.
State Lic.
City
DW 3142
& Classif.
Lic. #
Sq. Ft.
9
No. No. Dw.
Arch., Engr.,
Size -
Stories Units
Designer
New O Add ❑
Alter ❑. Repair ❑ Demolition ❑
i Address
Tel.
.. _. ..
City
Zip
State
.. ..
. . . .
Lic. #
. LICENSED CONTRACTOR'S DECLARATION "
I 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?
"
I. effect.
SIGNATURE DATE
_
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
li 215,&&.00
reason: (Sec. 7031,5,Business and, Professions Code: Any city or county which• requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its -issuance also
requires the applicant for such permit to lila a signed statement that he is. licensed pursuant to
• PERMIT
- -AMOUNT
- the provisions of the Contractor's License Law, Chapter 9 (commencing with'Section 7000) of
.t
Division'3 of the Business and Professions Code, or that. he Is exempt therefrom; and the basis-
for the Any Section 7031.5 'any for
Plan Chk` Dep..
-
alleged exemption. violation of by applicant a permit
'subjects the applicant to a'civil'penalty of not more than five hundred dollars ($500):
Plan Chk.. Bal.
w
O 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
Const.
st93.44
r - l6J.v61
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,.
Mach.
�A
55 00
SCJ.t7V
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
Electrical
128,65of
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-
Plumbing
Q(��C�
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
S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt. under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
2,0W.00
WORKERS' COMPENSATION DECLARATION
Ihereby 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 -
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
_
CERTIFICATE OF EXEMPTION FROM
REMARKS
- WORKERS' COMPENSATION INSURANCE _
(This section need not be completed if the permit is for one hundred'dollars ($100) valuation
orless.)
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. '
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must' forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
I-
Front Setback from Center Line
•
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY .
Side Street Setback from Center Line
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.).
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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.
192747
I certify that I have read this application and state that the above information is correct.
Issued by:
Date Permit
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.' I 'r, .
)
)—Date
Validated by:
Signature of applicant J t. .` - ;'
.��
Mailing Address >< ' ''�
Validation:
City, State, Zip
A7111
1 30 :5 '8 '61
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL F
NO. PLUMBING FEES
1ST FL. SO. FT. @
UNITS
COLL. AREA
SLAB GRADE �. X
UGH PLUMB. „C "1
//
",21FORMS
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
HEATING (ROUGH)
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. Q. FT. @
GAS (FINAL)
TEMP. POLE
WALL SQ. FT. @
DRINKING FOUNTAIN
SO. FT. @
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
AL INSP. 9/O
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
—CU.
plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
INAL INSP. 1c)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
(,�G 7'U k/K�6p
0 Z/,A L(—
LAUNDRY TRAY
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.
SQ. FT. @ c
BATH TUB
SPARK ARRESTOR
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
UX -LATHING
SQ.FT.GAR @ 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
INSULATION/SOUNDL/ —^�
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 / j`/—IOUND
PLUM G ?
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE �. X
UGH PLUMB. „C "1
//
",21FORMS
BONDING
HEATING (ROUGH)
STORAGE TANK
EWER OR SEPY�L T K
UGH WIRING (i �1r,g,,)
DUCT WORK
ROCK STORAGE
/J/_FOUND. REINF.' r+.
Y
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
L!/ REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
AL INSP. 9/O
BOND BEAM
WATER SYSTEM
$
GRADING
—CU.
plus x$
_ $
LUMBER GR.
INAL INSP.
A
/ FRAMING �i � G�
INAL INSP. 1c)
OOFINGQlC/G 3,3y
(,�G 7'U k/K�6p
0 Z/,A L(—
v�"�S _F I ,�Zl�
%j/ �a L( — ?0 — 7 %
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
UX -LATHING
MESH
INSULATION/SOUNDL/ —^�
FINISH GRADING
eLPINAL INSPECTION? -10
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL