003222 (SFD)ti
4
P.O. BOX 1504 No. 003222
Building 78-105 CALLE ESTADO
Address 54--824 InVerrsesss LA QUINTA, CALIFORNIA 92253
Owner ......
Mailing
Address
City 1pd _. x
.halm Desert 92260
Contractor
.1 . National Mort4a
Address
BUILDING: TYPE CONST.:OCC: GRP..
.►,.. , t... A.P. Number PGA Tiest
�"- Legal Description
' Project Description rr�ase 266 Plan !.MRfit lir&n-
HARD COPY
City
Zip
Tela
State Lic.
& Classif. .. 208130
City
Lic. #
Sq. Ft. DWa 16.27 No. No. Dw.
Size - G -424 • Stories • Units
Arch:; Engr., ..
Designer
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
-
Lic. #
A
'i 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
effect.;fc%
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
. 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:applicanutor 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 b/'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):
• ❑ 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
. Professions Code: The contractor's License Law does not apply to an owner of property who
Estimated Valuation.
� .� ,. Ail
PERMIT AMOUNT
,a
Plan Cihk. Dep.
Plan Chk. Bal. 38044
•
Const. ��.�
•
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements, are not intended,or of/eyed./or sale. If,, however, the building .
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.)
Mech. - •'�� •
Electrical -I +y
`�# ,. 41
,
Plumbing
87. 50
❑ 1, 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 o/ property who builds orimprove8 thereon, and who contracts for
such projects -with a contractor(s) licensed pursuant to the Contractor's License Law.)
O [am exempt under Sec. • B. 8 P.C. for this reason
. .
S:M.I.• t> C.A
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
O Copy is filed with the city. q Certified,copy is hereby furnished.
TOTAL $2,751 .21
- _ �
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ the permit is for one hundred dollars ($100) valuation
.. or less.) . .. - - •. -ty
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.
REMARKS • 2
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Date' Owner
NOTICE TO APPLICANT: If, 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. - -
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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
Side Street Setback from Center Line
Side Setback from Prope.rty.Line
Lender's Address
FINAL DATE INSPECTOR
Issued by: Date .15 8%Permit
Validated by:
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 ciy 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.
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. 50. FT. ® $
2ND FL., SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. 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
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
ROUGH PLUMB.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASIAER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROUGH WIRING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
DUCT WORK
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.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1114 c
SEWAGE DISPOSAL
WATER HEATER
SO.FT.GAR p 3/4c
HOUSE SEWER
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FE PPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
Of
GROUND MB NG~NDERGROUND
;j2
A.C. UNIT
COLL. AREA
SLAB GRADE (tl/r"609z
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
01 SEWER ORS PTI TANK k
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REI NF.
/
e5l aAS(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
'$"plus
GRADING
yd.
x$
_$
LUMBER GR.
/D ;0
FINAL INSP. IV/04
FRAMING /v '�� ®�
INAL INSP.
ROOFING /dL
S /vl
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 4- V/L,/ ®
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL