002239 (SATT)44
P.O. BOX 1504 No.. 002239
Building 856 U@ f, 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
mailin
Address
%S+-005 C*Mtxy C,Ub Dr.
City
Palm Deseft
Zip
92260
Tel.
5682828
Contractor
"
Address
Scm
' City":;a=Zip
' . .Q/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, atter, 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 o/ the Contractor's License Law, Chapter 9 (commencing with Section.7000) of
Division 3 o/ the Business and Professions Code, or that. he is exempt therefrom, and'the basis
for the alleged exemption. Anyviolation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars .(S500):'
❑ 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 o/ property who
builds orimprovesthereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered /or sale. If, however, the building
or Improvement is sold within one year of completion, the owner -builder will have the burden
o/ 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 o/ 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 I am exempt under Seca B. & P.C. for this reason -
Tela
State Lic.
& Classif.
288130
City
Lie. # 328
Arch., Engr.,'
Designer
Mech.. _
Address
Plumbing
Tel.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description. P" '111M VLM 30
Rnaw7B
Sq. Ft. 2$25 No. No. Dw.
Size . GM 56a • Stories Units -
New ❑Z Add ❑ Alter ❑ Repair ❑ Demolition ❑
City
JZip
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.infull force and
effect.
"
SIGNATURE •yr �. ,+.'. e� i. -k ••«.. ►..-^4,.. i i DATE
.
' . .Q/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, atter, 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 o/ the Contractor's License Law, Chapter 9 (commencing with Section.7000) of
Division 3 o/ the Business and Professions Code, or that. he is exempt therefrom, and'the basis
for the alleged exemption. Anyviolation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars .(S500):'
❑ 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 o/ property who
builds orimprovesthereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered /or sale. If, however, the building
or Improvement is sold within one year of completion, the owner -builder will have the burden
o/ 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 o/ 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 I am exempt under Seca B. & P.C. for this reason -
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; 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.
CERTIFICATE OF EXEMPTION FROM
.WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
• or less.)
I certify that in the performance of th@ 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: It, 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. -
TOTAL
178,307.00
AMOUNT
• � .J4yy//i�• {L•��7
��
..���J
1 -71
136.50
12.36
REMARKS
ZONE: BY:
Minimum Setback Distances:
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,Llne '
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 if work thereunder is suspended for 180 days.
i�7—iy
I certify that I have read this application and state that the'above information incorrect. Issued by: Date �VSI Permit
1 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. Validated by:
i�:; ;. r
Signature of applicant � 2 - r Date * v
Mailing Address t' �' ! Validation:
City, State, Zip
A5U96 4 8-.1 :5485,17 CK
HARD COPY
CONSTRUCTION ESTIMATE
Aft
NO. ELECTRICAL FFAft
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SO. 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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
,�G ROOFING n ,'
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 p
UNDERGROUND
A.C. UNIT
COLL. AREA
)A SLAB GRADE
( ROUGH PLUMB. 8
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
OUGH WIRING C
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
(/GAS (FINAL) /
TEMP. POLE
GROUT
WATER HEATER
SERVICE
XteINAL INSP. f.7, Lk
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
INAL INSP. // p /i
r
tG FRAMING Q f; �O/_
U¢
FINAL INSP.
,�G ROOFING n ,'
& �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING Gr
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION G,
CERT. OCC.
FENCE FINAL
IN5YtG I UI1'S 5R9NA I UMt511NI I IALS_
GARDEN WALL FINAL
ruc Qat,_,,vC q,5,Y(0,