001626 (PAT)44
P.O. BOX 1504 No., 01625
Building 78-105 CALLE ESTADO
Address 526-975 AvwuWa _N ru= LA QUINTA, CALIFORNIA 92253
Owner
Efta3i`1i Moffitt BUILDING: TYPE CONST.- OCC: GRP.
Mailing
Address
A.P. Number _
City Zip Tel.
. Legal Description
Contractor. Project Description
Sim go= Own.
Address . _.
X155 Cwt
City . Zip Tel..
State Lia City
& Classif.. Lic. # Sq. Ft. No. No. Dw.
_-Arch:, Engr.,- .. .. .. ._.
Size 476' Stories Units
Designer " New,Q Add ❑ Alter ❑' . Repair O Demolition ❑
Address Tel.
City Zip State
Lica#
LICENSED CONTRACTOR'S DECLARATION
I herebYy;affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code,'andmy license is in full force and
effectY }}-,� -t i # A
A 1 S,
SIGNATURE F. av,F._b`.. a;.e�� Ay 8n` DATE .. .. _ ..
OWNER -BUILDER DECLARATIONEstimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following .
reason: (Sec. 7.031; 5, Business and Professions Code: Any city or County which requires a A i AA.
permit to construct, alter,improve, demolish, or repair any structure, prior to its issuance also - AMOUNT
requires the applicant for 'such permit to file a signed statement that he is licensed pursuant to PERMIT -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section .7000) of =r. '
'Division' 3 of the Business and Professions Code, or that. he is exempt therefrom, and lhe'.basis
for the. alleged exemption. Any violation of Section 7031.5. by 'any applicant for a permit Plan'Chk. Dep...
• subjecwthe'applicant to a civil penalty of'not "more than five hundred dollars ($500). I. .
. ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 32ryy
�+4
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 ' Const. so so
builds or improves theieon and' who does such workhimself or through his own employees, M(jCh.
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 �EI2CtrICal
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- Plumbing
struct the project. (Sec. 7044, Business and Professions -Code: The Contractor's License Law C�
does not apply to an owner of property who builds or improves. thereon, and who contracts for - S.M.I. �0 '
such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
Grading
❑ I am exempt under Sec. B. & P.C. for this reason '
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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. ...O.Certified copy is hereby furnished.
TOTAL 8x3.82
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' shouldbecome ZONE: ' BY: '
subject to the 'Workers' Compensation provisions- of 'the 'Labor Code, you must -forthwith Minimum Setback Distances: '
comply with such provisions or this permit shall be deemed revoked. -
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
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 certify .that I have. read this application and state that -the above information is -correct. Issued by:' Date Permit• -
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. f
Validated by:
Signature of applicant �\ �! 4a�i Date -r
Mailing Address r �` " "�'` Validation:
City, State, Zip
A1944 7 _15 _. 83.82
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. 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
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
FRAMING
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
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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.
FRAMING
FINAL INSP.
ROOFING
/
REMARKS:
VENTILATION
' FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
'
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
I ' INAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL