09388 (SFD)i
P.O. BOX 1504 N o . 09388
88
Building 78-105 CALLE ESTADO
Address 47-320 Via Koran LA QUINTA, CALIFORNIA 92253
Owner
T4TT,MA rAcTrTc. X C BUILDING: TYPE CONST. OCC: GRP:
Mailing
Address 1301 Do.Ve Street A.P: Number
City - Zip Tel. '
iewport Bead 12660 714/851' 1411 Legal Descriptioq�f�ttx"cxit4�l grt� on7.s� ? T. f ItiA �►a
Contractor Project Description LOO 198 Plan 4
Address
City Zip Tel.
State Lic. City
& Classif.:47$ Lic. # 273® Sq. Ft. No. No. Dw.
Size ?i Stories Units
Arch., Engr.,,
Designer. tjal .3 nCl & MCS UUM Ltd. New ❑ Add ❑ Alter ❑. Repair ❑ Demolition ❑
Address Tel.
360-0250
City Zip State
k.
AMOUNT
1129.50-
221-36
3Q
193.50
5381.44
347.94
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
CONSTRUCTION LENDING AGENCY
I= 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 cityto enter the above-.
mentioned property for inspection. purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Rear Setback from Rear Prop. Lirie
Side Street Setback from Center Line
Side Setback from Property. Line '
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
Lfc. x-7424
LICENSED CONTRACTOR'S DECLARATION
I hereby affi m that I am licensed under -"provisions of Chapter 9 (commencing with Section
70 '0'df Qyision 3 of the Business anti Prof 1;sions oode, and my license is in fill force and
effect ,r / 10 f66'y 1
S GNATl1FEr L' y� DA
.. .
OWNER -BUILDER DECLOfA ON
I hereby affirm that I am exempt from the Cont S is 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 file a. signed statement that he is licensed pursuant to
Estimated Valuation
PERMIT. -
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
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. Dep.
Plan Chk. Bal.
Const.
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
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. If, however, the building
or improvement is sold within one year of completion, the owner-builder.willhave the burden
. of proving that he did not build or improve.for the purpose of sale.). - -
Electrical '
Plumbing
❑ 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 ownerof 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.)-
❑ I am exempt under Sec. B. & P.C. for this reason
,
Grading
Driveway Enc.
Date Owner
Infrastructure
-Art in Public
WORKERS' COMPENSATION DECLARATION
Ihereby 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. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
certify that in the performance of the 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.
k.
AMOUNT
1129.50-
221-36
3Q
193.50
5381.44
347.94
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
CONSTRUCTION LENDING AGENCY
I= 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 cityto enter the above-.
mentioned property for inspection. purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Rear Setback from Rear Prop. Lirie
Side Street Setback from Center Line
Side Setback from Property. Line '
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
1 UNITS
COLL. AREA
2ND FL. r SQ. FT. ®
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL" SQ. FT.
GAS (ROUGH) 7 �jj/i
cl
DRINKING FOUNTAIN.
SQ. FT. ®
OTHER APPJEOUIP.
URINAL
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`
r
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
=$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING �i LY
`q
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
FIRE ZONE ROOFING
SQ. FT. ® c'
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
SQ.FT.GAR ® 3/ac
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"
SETBACK 011 LI, CCC
GROUND PLUMBING q
Qt
4UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) 7 �jj/i
cl
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL •
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING -
w --cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. O
FRAMING �i LY
`q
FINAL INSP. _/ 3
ROOFING � �
^� /
/ �
REMARKS: '
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
RING O
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION 9-�Lf^93
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL