001893 (SFD)P.O. BOX 1504
Building78-105 CALLE ESTADO
Address 55-171 Ilwyer0 LA QUINTA, CALIFORNIA 92253
Owner I . '
mailing
Address 75-005 OMMtV Club Driila_
City Zip Tel.
Pal= :Dwert 92260- -%8-292a
Contractor
Address
No. 0{1393
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number
Legal Description
Project Description RM MST . ' PAX 40 IR
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
❑ Copy is filed with the city.. Q Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE r '
(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 the work for which this permit is issued, I shall not
employ any peon in any manner so as to become subject to the Workers"Compensation
Laws of Cali fornirsa.
Date Owner'"
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you. should become
subject to the Workers' Compdrisation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.-
CONSTRUCTION LENDING AGENCY
Ihereby 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 buil g permit when properly filled out, signed and validated, and is subject to
expiration if we thereunder is suspended for 180 days.
I per 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 1
construction, and hereby authorize representatives �of,this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant #- —' v+_ ,•?•�' Date. -r
Mailing
Mailing Address
City, State, Zip
HARD COPY
Infrastructure �erC}.C3t)
TOTAL�+Ei.
REMARKS
City
$
Zip
Sam$
Tela
14D BU= TSS.
State Lic.
& Classif..
City
Lic. # 328
MZ3142
Sq. Ft.'No.
Size IM�3g . • Stories
No. Dw.
Units
Arch; Engr.,
' Designer Ftbl=t AltM' •ASSOC.
New fi# Add ❑ Alter ❑
Repair ❑ Demolition ❑
Address �! ��y7
2915 i :H 1- )We.
Tell. _w +�
l i. ) 540—_-S �..g
Side Street Setback from Center Line
City
1''a 91-1vt
Zip
92626
State
Lic. #
Issued by:
Date �Permit-
Validated by:
LICENSED CON TRACTOR'S,XQLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing4lth Section
of Division 3 of the Business and Professions.Code, and my license� is -in fullPforce and.,,.,,
effect
+�
A318 %
11 13 .' _.35..80 1 7 CK
SIGNATURE DATE
rr 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
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
for the alleged exemption. Any violation of Section 7031..5 by 'any applicant for a permit
'subjects'the applicant to a civil penalty of notmore than five hundred dollars ($500).'
O 1, 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
builds or irriproves 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.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
• Strutt -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 contractors) licensed pursuant to the Contractor's License Law.)-
❑ I am exempt under.Sec. B. 8 P.C. for this reason
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep. ..
-
-
Plan Chk. Bal. '
x.19
Const .-
. -
'Mach. ' ' '•
r
55. ♦�yi VV -
Electrical
.
' '28Ei�s
s
Plumbing - �'
.
140.50
S.M,I.
1-.3.�JJ
3
Grading
Driveway Enc.
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
❑ Copy is filed with the city.. Q Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE r '
(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 the work for which this permit is issued, I shall not
employ any peon in any manner so as to become subject to the Workers"Compensation
Laws of Cali fornirsa.
Date Owner'"
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you. should become
subject to the Workers' Compdrisation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.-
CONSTRUCTION LENDING AGENCY
Ihereby 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 buil g permit when properly filled out, signed and validated, and is subject to
expiration if we thereunder is suspended for 180 days.
I per 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 1
construction, and hereby authorize representatives �of,this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant #- —' v+_ ,•?•�' Date. -r
Mailing
Mailing Address
City, State, Zip
HARD COPY
Infrastructure �erC}.C3t)
TOTAL�+Ei.
REMARKS
i AM SPA I= PAW CF TRW Pte.
14D BU= TSS.
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:
A318 %
11 13 .' _.35..80 1 7 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL F
NO. PLUMBING FEES
1ST FL. SQ. FT. ® s- ,
2ND FL. SO. FT. ®
POR. SQ. FT. @
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ. 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
TT
ROUGH PLUM
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
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)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINA)
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
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/.c
HOUSE SEWER
FINAL INSP.
ROOFING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE MECH.FEE
L.CK.FEECONST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE --1
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBING
-
3 S
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE��
TT
ROUGH PLUM
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS S f /
SEWER OR SEP
OUGH WIRINriIC7
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINA)
OTHER APP./EQUIP.
REINF. STE''
GAS (FINAL) L%/�
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMINGa
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
J
LATHING
MESH
INSULATIONISOUN� ?r P6
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL