001899 (SFD)4
P.O. BOX 1504 No.�
Building 78-105 CALLE ESTADO
Address SA -9-3`1 1TMP TW%_,%9 LA QUINTA, CALIFORNIA 92253
Owner
sb"t-120 BUILDING: -TYPE CONST. - OCC: GRP.
Mailing
Address 75-405 o,0 ltry club Dr. A.P. Number
City Zip Tel.
p 3M _. 32260 SW -2828 Legal Description
Contractor Project Description V= FLM 20 O
Mat -41. Tard mid Rbc
.Address
City ' - Zip Tel: "
scim > _
State Lic. City rM.2596
& Classif. Lic. # 328 Sq. Ft. No. No. Dw.
Size -. Stories Units
-Arch:, Engr., . .., -
Designer New :M Add ❑ Alter ❑ Repair ❑ Demolition ❑
A -
Address Tel.
.. .. ..2315. Red RM Ave. (714) . 540-5M _..
City Zip State _ .. ..
Lic. #
-LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing,withSeVion +
7000) of Division 3 of the Business and Professions Code, .and my license isiin full force and
effect i 'i /r ty %.1////_?/1K 6�
SIGNATURE - A' "+. Y ./ DATE- ;OWNER -BUILDER DECLARATION DECLARATION ' ' • Estimated Valuation
1 hereby affirm that I am exempt from the Contractor's License Law for the following ''� �♦'�
reason: (Sec. 7031; S,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 - PERMIT - AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing. with Section 7000) of
-Division 3 o/ the Business and Professions Code, or'that. he is. exempt therefrom, and the basis - �T -
/or the alleged exemption. Any violation of Section 7031.5 by 'any applicant. /or a permit Plan Chk.. Dep.'
subjects the applicant to a civil penalty o/ not more than /ive'hundred. dollars ($500). A !�
❑ I, as owner of the property,, or my employees with wages as their sole compensation, will Plan Chk. Bal. _ ; h"i , t' t 495.17
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COr1St. .801. �>�
Professions Code: 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, -i. GG+fiftt
provided that such improvements are not intended or offered for sale. If, however, the building Mech. 5.5 3JL0
or improvement is sold within one year o/ completion, the owner -builder will have the burden Electrical W.06of 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 132.50
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner o/ property who builds or improves thereon, and who contracts for S.M'.I. - - • • - 11.24
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
fJ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure 2,000.110
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 .
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 3#394.95
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE t�,�y+�� ��wR �R1 �w�1� �Y�lsf t�9� *a
(This section need not be completed i/ the permit is for one hundred dollars ($100) valuation ,FilyiJ.i i'fi.Ri�[ SPA b rFsr:•s - � rftft r-
or less.) -
I 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 ty!
Laws of California. 7La7fa0.a��Ww��
"'Date Owner '
MM
NOTICE TO APPLICANT: If, after making this Certificate of Exemptionyou 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 Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to t S.�
expiration it work thereunder is suspended for 180 days. j 1142-8q
I certify that I have read this application and state 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. �/ ,,��-7 %/� ,.••-•Vatidated by:
Signature of applicant +' f -• r� 1 r l� /_ Date" fs y _'�
Mailing Address t / i Validation:
City, State, Zip /' / 1
A 3 1 8 Z 11 13 3394,95 CK
HARD COPY
CONSTRUCTION ESTIMATE {
NO. ELECTRICAL FE
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL. $Q. FT.
POR. - SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. 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 (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
G XD,7
V r
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING
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
ROUND PLUMBING/O O
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEno/�A
ROUGH PLUMB. �/ _
I BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS •
SEWER OR SE
ROUGH WIRINC
DUCT WORK
ROCK STORAGE
FOUND. REINF. rpZ
G XD,7
V r
GAS (ROUGH)METER
LOOP 7��
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
i
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I N SU LATI ONISOU N D
FINISH GRADING
FINAL INSPECTION
CERT OCC.
FENCE FINAL .
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL