001900 (SFD)4
P.O. BOX 1504 No. 001900
Building 78-105 CALLE ESTADO
Address Invet ss LA QUINTA, CALIFORNIA 92253
Owner
Mailing -
BUILDING: TYPE CONST. OCC. GRP.,
Address 75-005 m C Dr. A.P. Number
City Zip Tel.
.. Palm Deseft 92260 558-282 Legal Description
Contractor. Project Description 141mr % 7_0 0
fI laid Wild b==
Address.
City. _ Zip Tela-
_
State Lia City MG 2596
& Classif. Lic. # 3228 Sq._Ft. No. No. Dw.
Arch., Engr.,
Size - ( 577 Stories Units 1
Designer �.� New lia Add ❑ Alter ❑ Repair ❑, Demolition ❑
Address Tel,
2915 11ed RM AM. Mi4) 50-5w
City Zip State
Lic. #
+" LICENSED_ CONTRACTOR'S DECLARATION, _ Y
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
SIGNATURE - DAT
OWNER -BUILDER DECLARATION ./e I -
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following 161,730.00 73
reason: (Sec. 7031. S, Business and Professions Code: Any city or county 'which requires a - ! 0.00
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 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 s .,- ,
for the alleged exemption. Any violation of Section 7031.5 by 'any, applicant for a permit Plan Chk. D'ep..
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 Plan Chk: Bal, ; p 495.15
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness andCOf1St. A
- Professions Code: The Contractor's License Law does not apply to an owner of 'property who , Uw00
builds or improves thereon and who does such work him- all .lf or through his own employees, Mecha AA
:provided that such improvements are not intended or. offered for sale. If, however, the building oa.Vta
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.) - yry
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing so
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. 11.24 -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .
Grading
O 1 am exempt under Sec.. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 2.000.00
WORKERS' COMPENSATION DECLARATION
A 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.. O Certified copy is hereby furnished.
TOTAL 3,394.95
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE �t P==
-
or
section need not be completed if the permit is for one, hundred dollars ($100) valuation ,SPA W= MW � 4� Py�x•��,�,y
•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 t0 become subject to the Workers' Compensation
Laws of California. M Bx= *%TAB.
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
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
Lender's AddressFINAL 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. 32,,,,24,, 85
I certify that I have read this application and state that the above information is correct. +Issued by: Date l�nn 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- f
mentioned property for inspection purposes. i' / Y/f!� ,....Validated by:
Signature of applicant • I -�� 4�` 7 Date
Mailing Address f " s V % Validation:
City, State, Zip )
A3181 11 13 3394,95 CK
HARD COPY
A T
CONSTRUCTION ESTIMATE `'
NO. ELECTRICAL FE
NO. PLUMBING FEES
IST FL. SQ. FT. @ $
2ND FL. SQ. FT. ®.
POR. SO. FT. @
GAR. Sp, FT. @
CAR P. SQ. FT.
WALL SQ. FT. @
Sp 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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
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
4 AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. @ c
BATH TUB
FINAL INSP.
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
VENTILATION
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 PLUM BI NG/ -7/0241
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE,3 �6
ROUGH PLUMB.?, /�.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPT
OUGH WIRIN(i3 6
DUCT WOR5
ROCK STORAGE
FOUND. REINF./e�i16 je
RT
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
I
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus -X$-=$-
$_$ROOFING
LUMBER GR.
FINAL INSP.
FRAMING •?
J
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND,` / t
FINISH GRADING O
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL