002676 (BLCK)r•-,
Building 55_405pebble Bea&,
Address
Owner
Mailing'
Address 75a3fl5 f
City
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
club Drive
Tel.
60 T • 563-282
ContractorNOtl. M. Jc4cpm and 19ili
Address
Sam
City Zfp Tel."
State Lic. City
& Classif. 2�sfy�3 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
No. 002676
BUILDING: TYPE -CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size 353 lin f' Stories Units
New [Q . Add ❑ Alter ❑.' Repair ❑ Demolition.❑
City
Zip
State
(—fbot high blmk Ali
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed -under provisions of Chapter 9.(6ommencing with, Section!
7000) of Division 3 of the Business and4P ofessions Code, and:my license is in full,force and
effect. X r.-�Y'.. .tea r:
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SIGNATURE „"' - A..r— �.. - f / / DATE
.. .. ..
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
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$ 8�
S
reason: (Sec.. 7031. , Business and Professions Code: Any city or county..which requires a
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permft to construct, alter, improve, demolish, or repair any structure, .prior to its issuance also
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requiresthe 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
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'Division 3 of the.Business and Professions Code, or -that. he Is exempt therefrom, and the basis•
for the Any Section 7031.5 'any
Plan Chk. Dep: "
alleged exemption. violation or by .applicant .for a permit
subjects the applicant to a civil penalty of not more thanfivehundred dollars ($500).
t� w e
Plan.Chk. Bal. 48,42
0 I, as owner of the property, or my employees with wages as their sole compensation; will.
do the work, and the structure is not intended oroffered. for sale. (Sec. 7044, Buisness and
Const. ". 74• a
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,
Mech.
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 '
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
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does not apply to an owner of property who builds or improves (hereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
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Grading
..❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
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
m
.❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL.5
CERTIFICATE OF EXEMPTION FROM
REMARKS
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 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
Laws of California.
Date • • Owner '
NOTICE TO APPLICANT: If, alter making this Certificate or Exemption • you should become
'
ZONE: BY:
. subject to the Workers' Compensation provisions of the Labor Code, 'you- must forthwith
comply with such provisions or this permit shall be deemed revoked. -
Minimum Setback, Distances: - -
Front.Setback from Center. Line
Rear Setback from. Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line'
1 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
• This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE INSPECTOR
expiration it work thereunder is suspended for 180 days.
I certify that I have this
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read application and state that the -above. information is correct:
I agree to
Issued by: Date Permit
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-purrp
inspection -purposes.
Validated b y :
Signature of applicant * �` f? / +- 1_ 121 Date
Mailing Address / +` y`
Validation:
City, State, Zip
A6.648 11 5 1.23.52- R
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
>
2ND FL. SQ. FT. ®
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. p
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. Q. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. ®
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER HEATER
SERVICE
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
FRAMING
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
REMARKS:
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SQ. FT. ® c
BATH TUB
MESH
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR p 3/ac
HOUSE SEWER
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 PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL