001897 (SFD)44
P.O. BOX 1504 No. 00.897
Building 78-105 CALLE ESTADO
Address 55-153 Invernes.-3 LA QUINTA, CALIFORNIA 92253
Owner _
nirnwimp
Mailing
Address 75-005 1 C11*.) 1*1w.
.City Zip Tel.
PaIM Desext 92 260 56"!-2 8
Contractor
Address
BUILDING: TYPE CONST.• - OCC: GRP.,
A.P. Number,
Legal Description
Project Description PM 1r'..a�` PIM 2:0
Date Owner
WORKERS' COMPENSATION DECLARATION
l 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 any"person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subjectto 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 fabove-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip > f
HARD COPY
Infrastructure f3�
TOTAL 'I .95
REMARKS
'ZONE:
' City """ " '
Zip
Tela
Front Setback from Center Line '
iSam
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
State Lic.
City
2596
INSPECTOR
& Class,if.
Lic.# 328
Sq. Ft.
GR 5??
No. No. Dw.
I
Arch., Engr:,
Size
Stories Units
A 3 1 8 4
Designer PablewtAtRUMM ARMC.
Newel Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
_ .2915 Fe R. AVe
p +y 1+�
. (f 14) 540-51
City
Zip
State
coft8
92626
Lic. #
LICENSED CONTRACTOR'S DECLARATION
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 imfull force^and
effect..
"/
SIGNATURE_- - �-" ,f -_ DATE
OWNER* BUILDER DECLARATION
hereby affirm that I am exempt. from the Contractor's License Law for the following
.• `•
Estimated Valuation
1610730.00I
reason: (Sec. 7031.5,Business andProfessions; Code: Any city or county which requires a
}
permit to construct, alter, improve, demolish, or repair any structure, prior to *fts issuance -also
requires the applicant.for such permit to file a signed statement that he is licensed pursuant to
PERMIT
..•' - AMOUNT
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of,
..s.
• Division 3 of 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
Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O I, owner
Plan Chk. Bal.
495.13
as 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 -
COf1St.�.
'
not apply to an owner of.property who
builds. or improves thereon and who does such work himself or through his* own `employees,
that improvements not intended
MBCh.
r P�:
provided such -are or offered for sale. If, however, the building
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, or sale,)
❑ 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.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
_
❑ I am.exempt under Sec.. B. tS P.C. for this reason
Driveway Enc.
Date Owner
WORKERS' COMPENSATION DECLARATION
l 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 any"person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subjectto 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 fabove-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip > f
HARD COPY
Infrastructure f3�
TOTAL 'I .95
REMARKS
'ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line '
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
A 3 1 8 4
-11 13, 3394,9.5 U
CONSTRUCTION ESTIMATE i" ;. • •
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. p
CARP. SQ. FT.
WALL SQ. FT. ®
SQ, FT, ®
ESTIMATED CONSTRUCTION VALUATION $
NO. ELECTRICAL FE
UNITS
MOBILEHOME SVC.
POWER OUTLET
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APPJEQUIP.
IKITCHEN 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
GRADING
cu. yd.
$ plus x$
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. 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 PLUMBINY
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE lo2"Q(p
ROUGH PLUMBa6 6'/f
BONDING
HEATING (ROUGH
STORAGE TANK
FORMS ��/ S i
SEWER OR SEPTIC TAN��
H WIRIN�
DUCT WORK
OCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
EINF. STEE � �z 6
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING (PLo26
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
.,OSULATION/SOUNDZ
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE. FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL