002229 (SATT)4
P.O. BOX 1504
Building
Address 80-396Pebble BeaCh LA QUINTA, CALIFORNIA 92253•
No. 002229
Owner
G y
BUILDING: TYPE -CONST. OCC. GRP.-
Mailing
Address
`MS Cbnr*-ry_ a�
A.P. Number
City
ZIp " Tel.
palm Dmxt
92260 568-2822
Legal Description
Project Description M TME MM 40 GSR
Contractor
tl �,t
Address :.
City ' -'
Sam
Zip
TeL
State Lic.
& Classif.' .s$as�i
City
Lic. #2 ..
DW' 3142
Sq. Ft. No. No. Dw.
Size- 471a . •Stories Units �*
' Arch- , Engr., -
Designer
New' Add ❑ Alter ❑ Repair ❑- Demolition ❑
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. \;- i..� :� i / jr - r /
- _ -
SIGNATURE i * %''e A' -'.i ? ✓ +' - i f�—'r 1 ,f - DATE
/' t "LOWNER•BUILDER DECLARATION
I hereby affirm that 1 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 astructure, 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 not more 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, Buisnessand
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 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.). - _
EStlmated Valuation
a'� .y
.349 0
S'197.349.00
Sny
+•
PERMIT AMOUNT "
'
Plan Chk. Dep. -
Plan Chk. Bal. . q
(,Oust. ��
Mech. - 9;
EIQCtrICal128.65
Plumbing •
❑ 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.)
a I am exempt under. Sec. B. & P.C. for this reason
- -
. S.M.I. -.g-'
.
Grading
Driveway Enc.
Date owner
Infrastructure 2v030.00
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. ❑ Certified copy is hereby furnished.
TOTAL
_
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
'
(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, after making this Certificate of Exemption you should become
- subject to the Workers' Compensation provisions of the Labor Code, you' must forthwith
comply with such provisions or this permit shall be deemed revoked
ZONE: BY:
Minimum Setback Distances: '-
Front Setback from. Center Line
Rear Setback from Rear Prop. -Line
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.) -
Side Street Setback from Center Line
-
Side Setback from Property Line
Lender's Name
FINAL DATE INSPECTOR
��
Issued by: Date Permit
Validated by:
Validation:
A 5 1 1 0 4 8 5581, 17 Cti
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 above-
mentioned property for inspection purposes.=
Signature of applicant /,-f s'. - " %�-"r * Dale /
Mailing Address 'J
City, State, Zip r
r HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEE
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. S0. 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
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
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
VCKFRAMING tip
4,'FINAL INSP. // '
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
WETBACK 5
'
ROUND PLUMBING]
UNDERGROUND
A.C. UNIT
COLL. AREA
C�SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEP Cl6N
QqOUGH WIRIN(Wl
DUCT WORK
ROCK STORAGE
Py FOUND. REINF.AS
(ROUGH) ^
1
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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. �` i)
VCKFRAMING tip
4,'FINAL INSP. // '
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND q
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
IN5FLUI UN'S WUNA 1 UML51INI I IALS.
GARDEN WALL FINAL
&( pq wlacL_ I0kra-4DK- al(j,(t �v