001894 (SFD)44
P.O. BOX 1504 No. 001894
Building 78-105 CALLE ESTADO
Address 55 -M niveniew LA QUINTA, CALIFORNIA 92253
Owner
a=im 0MVW
Mailing � � •
BUILDING: TYPE CONST. OCC.,GRP.
Address 75-005 OmInifty ClUb Er. A.P. Number
City Zip Tel.
Pal naseft 42 0 .568-20R. Legal Description
Contractor Project Description VM WOFM PLAR? 40 0
Nate 1 Land and Iftirtgage
Address _
s
-City- Zip Tel.
sam ! Sam
State Lic. City DW- 3142
& Classif. Lic. # 328 Sq. Ft. No. No. Dw.
Size 589 Stories 1 Units
Arch.; Engr:,
Designer p4bert Al.S AAAGC, Ne,wQ Add ❑ Alter ❑ Repair ❑. Demolition ❑
Address Tel.
2915 Pad EM 1M. (734) 540--5U7
City Zip State
.. eta 1 92626- Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter (commencing wit S ction R
7000) of Division 3 of the Business and Professions Code, and my license is.in"rfull-force,and
effect. .d r
_SIGNATURE i f' DATE -
OWNER -BUILDER DECLARATION y /
I hereby affirm that I am exempt;from the Contractor'sLicense Law for the following Estimated Valuation ja• '
reason: (Sec. 7031.5,Business and, Professions code:. Any city or county which requires a a
1010
permit to construct, alter, improve, and.,
or repair any structure, prior lo.its issuance also
requires the applicant for such permit to rile 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 fhe basis - '
• for the alleged exemption. Any violation or 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).
,❑ I, as owner of the property, or my employees with wages, as their sole compensation, win' Plan. Chk., Bal.,
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. . 678j € 0
Professions Code: The Contractor's LicenselLaw does not apply to an owner of property. who •
builds or improves thereon and who does such work himself or through his own employees, -.- y
provided that such improvements. are not lnte`nded or offered for sale. If, however, the building - Mech. 5+R%
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.) EIBCtfICal _ •65
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 1 140.5€
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's *License Law �•_ - Q
does not apply town owner of property who builds or improves thereon, and who contracts for S.M.I. `� - U.83
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 2#01010.00
WORKERS' COMPENSATION DECLARATION
keI hereby affirm that'l have a certificate of consent to self-inaure, or a certificate of ,
Worr's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy'No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL 3,5$0.17
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE ." Rg�[YFac,71 9A�
(This section need not be completed if the permit is for one hundred dollars ($100) valuation �Yti R MW SPA aY X Mt C& 4n" T+f{a"Wr
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 sous to -become subject to the Workers' Compensation * t
Laws of California.
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 " •� a 0 ,
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
expiration if work thereunder is suspended for 180 days.!, 1i �,,
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 inspectionpurpose � ,r^Vati'dated by:
Signature of applicant.__ Date + ,,,y
Mailing Address I 1 Validation:
City, State, Zip
A318.6�1'��3 3;8u.17 CK _
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FE
NO. PLUMBING FEES
1ST FL. SO. FT. ® $�
2ND FL. SO. FT.
FOR. SO. FT. ®
GAR. SO, FT. ®
CAR F. 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
ROUGH PLUM % �j Li
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK p
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.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
PLUMBINOS
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUM % �j Li
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS ,�'
SEWER OR SEPTI
ROUGH WIRIN�
/ '
DUCT WORK p
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL) )
6
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING p2Ge D V�
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE.ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWAL
LATHING
MESH
•INSULATION/SOUND ,$r j
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
-FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL