002694 (3&4)i
4
P.O. BOX 1504 N o .
002694
Building 78-105 CALLE ESTADO
Address 55-503 F,restcm LA QUINTA, CALIFORNIA 92253
Owner
I BUILDING: TYPE CONST. OCC. GRP.
Mailing
j Address 75-005 CDMVtZV Club Drive A.P. Number
CityZip Tel.
� � • 92250 7568-2828- Legal Description
Contractor Project Description W -111k VMT TIMM 13 T3
Address Plan 30 0
I
City' * Zip Tel'
se
State Lic. City 2825
& Classif. 22$130 Lic. # �2$ Sq. 5 $a Ft. No. No. Dw.
Stories Units
,Arch.,-Engr., -
Designer _ New E Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
r, LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
i 7000) of Division 3 of the Business and,Professions Code, and my license is in full force and
effect..
SIGNATURE"-'-- !'- DATE ..-
J r jOWNER•BUILDER DECLARATION P
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation S 178,30.(*
ry�� �
reason: (Sec. 7031.5,Business and Professions Code: Any city or county ,which requires a T 178, . rtW
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a'signed statement that he Is licensed. pursuant to - .w. 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 alleged exemption. Any violation'of Section 7031.5 by 'any applicant for"a permit Plan Chk..Dep.,
subjects the applicant to a civil penalty or not more'than five hundred dollars ($500). " . -
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal..���
do the work, and the structure is not intended or offered°for sale. (Sec. 7044, Buisness and Const.
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, Mech.
provided that such improvements are not intended or offered for sale. If, however, the building
e owner -builder will have the burden Electrical '
of improvementproving that he did, not build or improve for the purpose of sale.) ,
❑ 1, as owner of the property, am exclusively contracting• with licensed contractors to con- Plumbing 1_l6_5111
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. – 'L
such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
. ❑ I am exempt under Sec. B. ti P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure
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
❑ Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL -A..tlR_ .1'f
CERTIFICATE OF EXEMPTION FROM REMARKS
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 tha 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, after making this Certificate of Exemption you should become ZONE: BY:
subject to the, Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
I' - .CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line '
I hereby affirm that there is a construction lending agency for the performance of the
i 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 it work thereunder is suspended for 180 days. • �f� �
I certify that I have read this application and state that the above information is correct. Issued by: Date 1i-1-_s"'8i£Permlt
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� � J/ Validated by:
Signature of applicant �?`_ �f� N Vf t �7 r - r' Date
Mailing Address T Validation:
City, State, Zip
A6%39 11 14 54851 CC
HARD COPY
Y -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
UNITS
4tALAB GRADE , �_
ROUGH PLUMB.?
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
�L FORMS _
(SEWER OR SEA;VC Trfb' 6
ROUGH WIRING%.2 S
•J
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
AAS (ROUGH) /—G —�i
QQ
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
INAL INSP.5r .2 9
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING
ci
FLOOR DRAIN
MECHANICAL FEES
ROOFING
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
SPARK ARRESTOR
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GARDEN WALL FINAL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEEMECH.FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
Qi,SETBACK / —g—
ROUND PLUMBING. -
UNDERGROUND UNDERGROUND
A.C. UNIT
COLL. AREA
4tALAB GRADE , �_
ROUGH PLUMB.?
BONDING
HEATING (ROUGH)
STORAGE TANK
�L FORMS _
(SEWER OR SEA;VC Trfb' 6
ROUGH WIRING%.2 S
•J
DUCT WORK
ROCK STORAGE
2G /FOUND. REINF. �� /
50/
AAS (ROUGH) /—G —�i
QQ
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
WLREINF. STEEL _�/_ 1�
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
INAL INSP.5r .2 9
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$ _$
LUMBER GR.
GFINAL INSP. `�
FRAMING
ci
Oq4,eINAL INSP. 'J �� g
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
FIREWALL
/ /GAR.
��[ LATHING LJ
MESH
INSULATION/SOUND
FINISH GRADING
PteFINAL INSPECTION <,,) S 9 i
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL