002255 (SATT)4
P.O. BOX 1504 No. 002255
Building 78-105 CALLE ESTADO 1r
Address %-'223 TillAble Baach LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC: GRP.
Mailing '
Address Club Dr% A.P. Number
City lZip ITel.
Contractor
Address.-.
r
City lZip Tela
State Lic. City
& Classif.- Lic. #
2�A13t� 329
Arch., Engr.,
Designer
Address Tel.
City Zip State
.. .. - 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 in full force and
effect.. y {• ' +
SIGNATURE r 6 -,V., ri-•.-+'..!' j DATE
f f ' -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 rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9'(commencing with Section 7000) of
Di0sion 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 We civil penalty of not more than five hundred dollars ($500). -
O, l,, 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 improves thereon and who does such work himself or through his own employees,
provided that such improvements. are not intended or offeredfor 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.) - , -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law:)
O 1 am exempt under Seca B. & P.C. for this reason
Legal Description
Project Description WA'VMM M 30' 0
Sq. Ft. VW 282 No.
Size , QM $ Stories •
New 04t Add ❑ Alter ❑
Estimated Valuation
PERMIT
Plan Chk: Dep.
Plan Chk. Bal..
Const.
Mech.. .
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, ora certificate of
Work
e
r's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. , . Company
Q Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
No. Dw.
Units
Repair ❑,
Demolition ❑
AMOUNT
9.10
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 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 •'
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: - .l
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 it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
ISSued'by:
Date A -A- 0; Permit '
agree to comply with all city and county ordinances and state laws relating to building
-
construction, and hereby authorize representatives sof this city to enter the above-,
mentioned property for inspection purposes-.
Validated by:
! n
Signature of applicant ' -�'- 2 l f 7 Date r{/ d' ' '
Mailing Address y " 7%• ! ` ` i k_
Validation:
City, State, Zip
A5105
4 8 348517 Ch
HARD COPY
CONSTRUCTION ESTIMATE Amik
NO. ELECTRICAL EESdjIk
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. 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
aeeOUGH PLUM
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.0OOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
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.
SQ. FT. ®c
BATH TUB
WATER SYSTEM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/e c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
INAL INSP. 3 �/_
64/_ROOFING0�_ /7! /1, C /
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
UNDERGROUND
f6kg.C.
UNIT ? 7
COLL. AREA
SLAB GRADE
aeeOUGH PLUM
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
&OWER OR TI �
OUGH WIRING�I �/ G
_/ (�G
DUCT WORK
ROCK STORAGE
OUND. REINF. //3
! V
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
,A. REINF. STEEL 0,
&IGAS (FINAL) /1
TEMP. POLE
GROUT
WATER HEATER
SERVICE
C166AL INSP. /
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
YFINALINSP. /_
C
24/&FRAMING t� //
INAL INSP. 3 �/_
64/_ROOFING0�_ /7! /1, C /
Q w G�`(��i
/�► �Q ��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
&/LATHING U
MESH
�L NSULATION/SOUNqVJ
FINISH GRADING
(Lt' INAL INSPECTION
CERT. OCC.
FENCE FINAL
I UH'5 MUNA I UKLWINI I IAL5.
GARDEN WALL FINAL