003249 (SFD)44
P.O. BOX 1504 No, . 003249
Building 78-105 CALLE ESTADO
Address 54-809 Inverness- LA QUINTA, CALIFORNIA 92253
Owner
tis 1r• �-e''�'�
Mailing _ BUILDING: TYPE CONST. OCC: GRP.
� � '
Address 75 -00S. -Country Club D>~ivi A.P.-Number NAM Xaes
City Zip JTel.
Pale Desert . 9226n 56R 292€ • , , Legal Description
Contractor Project' Description U .%4t^ 41"A n .. IDI A;M - 'IMP
! n,n x11Rf 1 ttrMRfSt fTaEa T sara -
Address
City. .. Zip Tel.....
State Lic. City
& Classif.. 288130 Lic. # 32x. Sq. Ft. DWG 2825 No. No. Dw.
Size s ,- r Stories = Units
Arch:, Engr., __ �__w
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #'
LICENSED CONTRACTOR'S DECLARATION „
;� • I hereby affirm.that I am licensed under provisions of Chapter 9 (commencingwith Section +L'
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. .. 0 , ! »«.,� fi
SIGNATURE--+ - - - DATE - _ -
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following $194,'692.60
+(tp t rt
reason: (Sec.. 7031.5, Business and. Professions Code: Any city or county which requires a - $ 46+�G 60
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 • PERMIT AMOUNT
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division -'3 of the Business and'Professions Code, or dial."he is exempt therefrom, and the basis
for,the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a -permit Plan -Chk.. Dip.
subjects the applicant to acivil penalty of notmore than five hundred dollars ($500):
0 I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk... Bal. y.
• do he work, and the structure is not Intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractors License Law does not apply to an. owner of. property who Const.
Builds or improves thereon and who does such'work,himself or through his own employees, Mech' t `
provided that such improvements are not intended or offered for sale. If, however„the building . 5-5 . 410
or improvement is sold within one year of completion, the owner -builder will have 'the burden Electrical '�''
o/ proving that he did not build or improve for the purpose of sale.),.
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law 1.3
does not apply to an owner o/ property who builds or improves thereon, andwhocontracts for S. M. j; �, T�
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec.- B. & P.C. for this reason Grading
Driveway Enc.
Date . owner Infrastructure 2.000.00
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or's 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 aSraL4
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION. INSURANCE
(This section need not be completed i/ the permit is for one hundred dollars ($100) valuation - or less.) - -
1 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. iii.iyi1; :t `Ys3si+a: 1 `JI iia`t�t
Date Owner '
NOTICE TO APPLICANT: If, after making this Certificate o/ 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
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line • -
I hereby affirm that there is's construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, CivibCode.) 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. / to
I certify that I.have read this application and state'that the above information is correct. Issued by: Date '7/20! 8 Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
'1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. I SQ. FT.
WALL SO. FT. ®
SQ, FT, ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/aC
HOUSE SEWER
REMARKS:
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
RCUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ - -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL