002240 (SATT)Qum&.
P.O. BOX 1504 No-.
Building
Address 80-432 P
lis ! LA QUINTA CALIFORNIA 92253
Owner • . .. .. . .
Smuise Cmpwy
002240
Mailing
BUILDING: TYPE CONST. OCC: GRP. -
Address 75—W5 Ctuafty CUb Dr.
A.P. Number -
City
ZipTel.
palm Des
9226
'2878
Legal Description
Description 17M VM '110=7 30 0
� 7 B
ContractorProject
Mtl M� and LMd
Address
' City
Zip
Tel
State Lic.
& Classif.. 288130
City
Lic. # - 3n-
EM 2825
Sq. Ft.No. No. Dw.
Size >g•Si - Stories Units
Arch., Engr., . ..... . .
Designer
New EIK 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.
_
SIGNATURE F '!N C -. ' r rr" .. R-'• F t ---td-.-! �' DATE
7 -OWNER•BUILDER DECLARATION
I hereby affirm that I am exempt from tAe Contractor's License Law for the.following
reason: r(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 file a signed statement that he is licensed pursuant to-
the provisions o/ the Contractor's LicensejLaw, Chapter 9 (commencing with Section 7000) of
Division 3' of the Business anis 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 /or 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 /or the purpose of sale.)
Estimated ValLfation Q �{
$ 1 f 0/307.00
- .'PERMIT AMOUNT
- - -
Plan Chk. Dep.
„
Plan Chk. Bal.. s0
(;Oust. {��� 50
Mech. - �j ,i jQ
'
Electrical -
Plumbing 136.50
❑ 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.)
0 I am exempt under Sec. B. 8 P.C. for this reason
_.
S.M.I. 12 .36
Grading
Driveway Enc.
_ Date owner
Infrastructure 2,0.00,00
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.
TOTALr�tJ. Ji
' 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 o/ 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
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 Street Setback from Center Line
Side Setback from.Property Line
Lender's Name
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
A5097 4 8 ;485,17 CK
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 inspec�onpurposes. r' ! %
Signature of applicant ` = t + %rlLr Date,
Mailing Address T f I " J "
City, State, Zip r f
'
r HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL md1k
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
AS (ROUGH)
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, TEM/PERM
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
6.eGROUND PLUMBINGL�
J
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
(,./,,ROUGH PLUMB. fr
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
l/tOUGH WIRING e7e G
•L 0
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
nr REINF. STEEL /Q, S
GAS (FINAL) / �G�
O
TEMP. POLE
GROUT
WATER HEATER
SERVICE
(�-FINAL INSP.,/ 1pI p
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
INAL INSP. /�
!
FRAMING O
G�fZU
FINAL INSP.
ROOFING C
6
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
r6eiLATHING Ol
MESH
INSULATION/SOUND
FINISH GRADING
`i,:f FINAL INSPECTION
CERT. OCC.
FENCE FINAL
1'IJrCV I V R J JI V AH I Y RCJII IYI I IMLJ,
GARDEN WALL FINAL
LCA %J •� w✓1CL 0JrSJ#