003233 (SFD)4
P.O. BOX 1504 No: 003233
Building 78-105 CALLE ESTADO
Address 54-880 Inverness LA QUINTA, CALIFORNIA 92253
Owner - ... _ . ... .
BUILDING: TYPE CONST. • OCC: GRP.
Mailing
Address �y A.P. Number PGA WeSt
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..City .. �Ip.....__...x '•` Tel °` "'"...� .. _ .. ., .: _ . _ . . _ ..
�s Dea4 � . 92260 Sad -282$ Legal Description OWL Al
ContractorProject Description P i�fa 'P.1 an'IN
14tional Mortgage a Land
Address
City .. -Zip Tel.... .
State Lic; ,: City
& Classif1 288130 Lic. # 328 Sq. Ft. VWG 1330 No. No. Dw.
.
Size ;, - - R - Stories- • -Units
Arch:,.Engr '
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
_ - LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that,l am licensed under provisions of Chapter 9 (commencing with Section c
7000) of Division 3 of the Business and Professions Code, and my license is in full force and '
effect... �'/� I ,,. .A -7
SIGNATURE$..✓' Y Rr. ... r , c 4:r r DATE
OWNER -BUILDER DECLARATION
DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for -the following
reason: (Seca 7031.5,Business and Professions Code: Any city or county .which requires a v r
Permit to construct, alter, improve,., demolish, or repair any structure, prior to its issuance also • - •x
requires the applicant for 'such permitrto file a signed statement that he is licensed. pursuant to -PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing., with Section 700 0) of
Division 3 of the Business 'arid Professions Code, or•that.he Is exempt Yherefrom;-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. A 1A2., A01
do the work, and the structure is not intended or offered for sale. (Sec. 704'4, Buisness and Const.
Professions Coder 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 AF jDa
or improvement is sold within one year of completion, the owner -builder will'have the burden Electrical '
of proving that he did not build or.Improve for the purpose of sale.) - MCI aft
O 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- _. _ -
does not apply to an owner of property who builds or, Improves thereon, and who contracts for S.M.I. r�
such projects with•a contractor(s) licensed pursuant to the Contractor's License Law.) - -
Grading
O I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure,,•
WORKERS' COMPENSATION DECLARATION
' I hereby affirm that' I'have a certificate'of consent to' self -insure, of 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.
TOTALi-
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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' Owrier
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. -
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 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 city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
.r1CIVIHI'fRJ -
ZONE:
BY:
Minimum Setback Distances:
Front. Setback from Center Line
T
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL.DATE
INSPECTOR
Issued by:
Date 's!'1 4 Y a Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. A, ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT:
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. , 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
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REINF. STEEL
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ® c
BATH TUB
FRAMING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vac
SEWAGE DISPOSAL
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
09 01
GROUND PLU N UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE WjOt7
ROUGH PLUM . BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER O S PIC TA K ROUGH WIRING
WORK
ROCK STORAGE
n
FOUND. REINF.
S (ROUGH) !1 METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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/
VENTILATION
5 f'� .�� �// /�Z/�
/
D��/ 71�
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REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND'
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL