002197 (SATT)Building 80'"449 PeWa Belach
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 75-005 �s Clut Dr.
City Zip Tel.
- Palm :t 92260 1 558-2828
Contractor
Address.
saw(Zip ITel.
State Lic. I City
& Classif: 130 Lic. # 328
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. N
SIGNATURE \+ /'" - DATE
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, priorto its issuance also
requiresthe applicant for such mit 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 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 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 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-
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 Sec. B. & P.C. for this reason
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
O.Copy is filed with the city. O 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 the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
- Date Owrier
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. '
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 above-
mentioned property for inspection purposes. /
Signature of applicant \ y . Date_' I
Mailing Address
City, State, Zip
HARD COPY
No. 002197
BUILDING: TYPE CONST.
A.P. Number
Legal Description
(Project Description
_
OCC: GRP.
' V= FIMM 2 I
Plarx 30 C
Minimum Setback Distances:
Front Setback from.Center Line
DM 2825
i Sq. Ft.
Size M 560
No. No. Dw.
Stories 1 Units I
New Cilt Add ❑
Alter ❑ Repair ❑ Demolition ❑
L
r-
INSPECTOR
Issued by:
Date1$6 Permit
Validated by:
Validation:
Estimated Valuation
�y «�
$ 178, 307.00
, PERMIT
+n
AMOUNT
Plan Chk. Dep.,
Plan Chk. Bal.
529.10
Const.
630.58
Mech:55.E
Electrical
i2i...7i
Plumbing
136.50
S.W.
12.36
Grading
Driveway Enc.
Infrastructure
2,000,00
TOTAL
3,485.17
REMARKS
POM AM SPA NM PAW U k 12W3 I?Lfll1l:
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:
Date1$6 Permit
Validated by:
Validation:
A4840
3 18 348517 Ck
CONSTRUCTION ESTIMATE Aghk
NO. ELECTRICAL FEoJ&
NO. PLUMBING FEES
1ST 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS 'T
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/e c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
T SETBACK S &ly
1
LA GROUND PLUMBINGPI � i
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 'T
-# SEWER OR SEPTI K� T
C
fWOUGH WIRING 7 g
r`
DUCT WORK
ROCK STORAGE
i FOUND. REINF. (,
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING .
cu. yd.
$ plus x$
_$
LUMBER GR.
q-16NAL INSP. 16
FRAMING 7 CDILAINAL
O
rrr111
INSP. 1/S - p
/v /
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
Lii,KINSULATION/SOUND 7
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
IIVJYCt:I V M"J Jlla 19A I V RCJIIMI I IALJ, '
GARDEN WALL FINAL
51114 Of -4 w In'cL- 9^1