002697 (3&4)LEAVY 4
P.O. BOX 1504 No. 002697
Building 78-105 CALLE ESTADO
Address C&-539 Firesbom LA QUINTA, CALIFORNIA 92253
Owner _ ... .. ..
BUILDING: -TYPE CONST. OCC: GRP.
Mailing
Address 75-005 ClciuntXY Club DriVe
City Zip Tel.
Para Desert 1 92260 568 -
Contractor
City
rs'c
State Lic.
& Classif.:,_f
Arch., Engr.,
Designer
Zip Tela .
City
b Lic. # 328,
A.P. Number
Legal Description
Project Description
%MT Pie 13 $
1*1m 30
EM 2325
Sq. Ft. 568 No. No. Dw.
Size Stories Units
New Add ❑- Alter ❑ Repair ❑ Demolition ❑
f Address Tel.
l City Zip State
l 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 isinfull force and
effect!
SIGNATURE 0' DATE—
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
reason: (Sec. 7031.5,Business and Professions Coder Any city which requires a
'
PERMIT' ••
,or.county
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
the provisions of"the Contractor's 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
Plan Chk. Dep..
subjects the applicant to a civil penalty of not more than five hundred dollars'($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
Const..
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Code: The Contractor's License Law does not apply to an owner of property who ;
Mech.
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. ff, however, the building
Electrical
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.) - ..
Plumbing
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
.
S. M.1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O I am exempt under. Sec: B. 8 P.C. for this reason
Grading
Driveway Enc.
Validation:
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
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
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, 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: ll, after 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 slate that the above information is correct.
I agree to comply with all city and county ordinances and state lays 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 i !
City, State, Zip `
HARD COPYI
178, 307.00
AMOUNT
[7.74+w«i17
. 55.09
qA ��.t7•..71
12, 3ti
2.000.00
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 ermit
'Validated by:
Validation:
A6740
11 14 5485.7.7 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL Q9ft
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
UNITS qw
COLL. AREA
?L,CSLAB GRADE ,. _ ¢
I -TOUGH PLUG.- a
YARD SPKLR SYSTEM
2ND FL. S0. FT.
HEATING (ROUGH)
STORAGE TANK
Z(S,I�FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
I ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CARP. SO. FT. ®
I
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN
SO. FT. ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
(,"AL 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
C
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SQ. FT. RESID ® 1 Va C
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
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
etZSETBACK _
�OUND PLUMBINq q
UNDERGROUND
A.C. UNIT
COLL. AREA
?L,CSLAB GRADE ,. _ ¢
I -TOUGH PLUG.- a
BONDING
HEATING (ROUGH)
STORAGE TANK
Z(S,I�FORMS
LBEWER OR S LPTIC K
�� UGH WIRING 7
v
�^�
DUCT WORK
ROCK STORAGE
V�i,FOUND. REINF. n r /
aLQAS (ROUGH) ` /
?l
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
26,,�REINF. STEEL 1/2 — 3i -FC
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
(,"AL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
=$�
LUMBER GR.
CIZ-MAL INSP. �� ,�
/ FRAMING
f
C
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
Zb—ALATHING Ll %
MESH
r H INSULATIONISOUND v/
FINISH GRADING
INAL INSPECTION —
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL