001788 (SFD)*Ttylrw,PF
P.O. BOX 1504 NQ, 001T88
Building
Address sell inverrew LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC. GRP.
Mailing r.
Address ommtr t club Dr. A.P. Number
City ZipTel.
r4mL� . 2200 SU -2828 Legal Description
Contractor Project Description PM- Imo.' KM 30 O
Nat' 2 iii M=bjaga
Address
City Zip Tel. -
Sam
> .raw
State Lic. City
& Classif. Lic. # 328
Arch., Engr.; -
Designer lkgX�ft A.teVgWS A_q.
Address Tel.
291.5 Pied X11. A'ii'e. (71$) 540-5U7.
City Zip State
00B mem 92626 Lic. # .
' • _ . LICENSED CONTRACTOR'S DECLARATION. r
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—
effec
_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, 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 •:a
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 301 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
buildsor 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 will have the burden
of 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-
.-strucl 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law:) -
.❑ 1 am exempt under Sec: B. & P.C. for this reason
Date Owner
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
0 Copy is filed with the city. , ❑ Certified copy is hereby furnished.
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 anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California.
D '
Sq. Ft. am s6sNO.'
Size
Stories 1
No. Dw. 1
-Units
New M Add ❑
Alter ❑
Repair ❑ Demolition ❑
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 a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) -
Side Setback from Property Line '
Lender's Name
Estimated Valuation
Lenders Address
'
PERMIT
INSPECTOR
AMOUNT
Plan Chk. Dep.
expiration if work thereunder is suspended for 180 days.
Plan Chk. Bal.
i
529.1
Const.'
Date Permit
630.50
Mech.
s.{ir%
Electrical
121.71'
Plumbing
136.50
S.M.I.
- 12.36
Grading
City, State, Zip
Driveway Enc.
Infrastructure
11 13 348
2,000.00
TOTAL
3,495.17
REMARKS
i:``I�.A,tJ L:i:sY.s .a:,'xi Ynsz�
Yi-.x�.i. �,Fa' a.:.ewi +':...... xi.�•
S.#i.1�,i1..Yr kJ. aBJtlis
ate 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
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: '
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 a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) -
Side Setback from Property Line '
Lender's Name
Lenders Address
'
FINAL DATE
INSPECTOR
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
I certify that I have read this application and slate that the above information is correct.
Issued by:
Date 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. r r
Validated by:
Signature of applicant I ! t �• > Date •
Mailing Address /
Validation:
City, State, Zip
A 3 1 7 6.
11 13 348
HARD COPY .
CONSTRUCTION ESTIMATE Y.
NO. ELECTRICAL F
NO. PLUMBING FEES
1ST FL. SO. FT. ®
NO FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. 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
HEATING (ROUG )'
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY -TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL) ►
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GA.,
SO.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
SETBACK
0./%,ROUND
PLUMBING fol e?O r
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE I 11.3L6
ROUGH PLUMB.// /
ro
BONDING
HEATING (ROUG )'
STORAGE TANK
FORMS
SEWER OR SEPTIC
UGH WIRING !!
DUCT WORK
ROCK STORAGE
s�
FOUND. REINF. If 6
GAS (ROUGH)
METER LOOP
HEATING (FINAL) ►
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GA.,
FRAMING3
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUNDJ(&re
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL