002258 (SATT)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 80-488 PlobblA Wit. LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75-05 Omiv Mpb ftive
CityZip Tel.
' 2260 %8--2828
Contractor
_ Address w
SIMM
City izip Tela
State Lic. City
& Classif. Lic. #
'Arch., Engr.,
Designer
Address t 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.
_SIGNATURE + M i f ,Y w + • /..' {. �.r. r. �,... i" r + • DATE
/OWNER•BUILDER DECLARATION
I hereby affirm -hat I am exempt from the Contractor's License Law for the following
reason: -(Sec. 70SI.5,Business and Professions Code: Any city or county which requires a.
No.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number.
Legal Description
Project Description St VM TWI30
OR
PbaW, 8 B
Sq. Ft. ` 2625 No. No. Dw.
Size € ' 568 ' Stories • 1 Units 1
New Q Add ❑ Alter ❑ . ' Repair 0 . Demolition 0
Estimated Valuation
t '1174 fu
. 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
-PERMIT
AMOUNT
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 Any Section 7031.5 'any for
Dep..
alleged exemption. violation of by applicant a permit
' subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ' ' .
.Plan-Chk.
-
Plan Chk. Bal.
rj2g,
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 or offered for sale: (Sec.. 7044, Buisness and
Const.
�� 5
Professions Code: The Contractor's License Law does -not apply to an owner or 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 or completion, the owner -builder will have the burden
Electrical
4
'1
of proving that he did not build or improve for the purpose or sale.)
_
s��
0 I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
�
1..6.50
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
S.M.I. °
12.36
- • such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
-
Grading
.O I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
2,000.00
WORKERS' COMPENSATION DECLARATION
thereby '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
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
3,485.17
_
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, 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:
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 if work thereunder is suspended for 180 days.
I certify that I have this
read application and state that the above information is correct.
ISSUed by:
DatePermit
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. i -
Validated by:
'
I^ n
Signature of applicant*
pplican �'/ J iT % f l :�� _ Date f ;+
Mailing Address 7 a l `) t r "
Validation:
City, State, Zip
A_5108
4 8_. X485,17 .0
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EES90&
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT. p
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
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)p- ��
0
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
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.
SO. FT. ® c
BATH TUB
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.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
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE��� (�
IN
K�ROUGH PLUM
BONDING-
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SE 2/�4f
ROUGH WIRING Dnd
o O� ,
DUCT WORK
ROCK STORAGE
iLl( FOUND. REINF. //' b
YQ
GAS (ROUGH)p- ��
0
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL 6
O
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
_$
LUMBER GR.
am, INAL INSP. /
SLK FRAMING
O�
INAL INSP. 11 /1
t ✓ 1
Zql( ROOFING P /a 0
r �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
lg4t LATHING 3 ft
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL
V) g-/ w A"(. V-L-Ic, a?/ ( If, d 9