002607 (SFD)Building
Address
Owner
Mailing
Address
City
Address.
Sam
s
P.O. BOX 1504 No. 002607
78-105 CALLE ESTADO
►089 08k RM LA QUINTA, CALIFORNIA 92253
I`IP
BUILDING:. TYPE CONST. OCC: GRP:• -
A.P. Number
Legal Description
Project Description I t,M'±-, +7=MMP I'A . A
City " -Zip
.
Tel. -
State Lic.
• & Classif.z�i3
City
Lic. # 328.,
� �
Mn1330
Q' Ft :
S ".
Size •
No. No. Dw.
.424 Stories " • Units
Arch.; •Engr.,
Designer
New ® Add ❑ ' Alter ❑ Repair ❑ . Demolition ❑
Address
Tel.
City
City 7_7
Zip
State
Lica#
tl
LICENSED CONTRACTOR'S DECLARATION
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. . IV"' . .. .k . s;K% . .r - .. , • i
' SIGNATURE -' `DATE
OWNER -BUILDER DECLARATION
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,' prior to its issuance also
requires`the applicant /or such permit to file a signed statement.fhat he is licensed -pursuant. -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/
Divisiori 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).
❑I, as owner of theproperty or my employees with wages as theirsole comp"en' sation, will.
do the work, and"the,structure is not intended or offered for sale. (Sec., 7044, Buisnessand
Professions Code: The Contractor's License Law does not apply to- ari 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,.
Estimated V81UatlOn
- - - -
_ PERMIT ' "' - '- .AMOUNT '
.. -
Plan Chk:•Dep.:- • - -
.. - .. '
Plan Chk. Bal.324.%.-
..COr1St. �* - 351.00 -'
Mech.
' 'EIBCtrICal
•� -
. 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.),
_
Plumbing'
- - -
- 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'Con(ractor'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.)
❑ I am"exempt under Sec. B. 8 P.C. for this reason
S.M.I.
- ^
'-
Grading
-
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
4 ' A 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. ..❑ Certified copy is hereby furnished.
TOTAL
'17ri?
REMARKS.
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 thg work for which this permit is issued, I shall not
employ anyperson 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 o/ "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. • • -
. ZONE:.. BY:
'Minimum Setback Distances:. '
- - -
'
Front Setback from.Center Line
_
Rear Setback from Rear Pro.p..Line
_ CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performarice 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
' Issued by:
Validated by:
INSPECTOR
9-30.,,86
- Date Permit
_
Lender's Address
^ This is a building permit'when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days:
I certify that I have read this application and state that the. above information is correct.
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-. 7
mentioned property for inspection purposes. . • -
Signature of applicantDate_
Mailing Address 1. r r" ' e
Validation:
A6.439
9 30 2 i X9.42 Tl
- City, State, Zip J
'
' - HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CARP. SQ. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) ` `1�0
/ l
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
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
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
1UyGROUND PLUMBING/v.
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPTIC !
04eOUGH WIRING
DUCT WORK
ROCKSTORAGE
%(lL FOUND. REINF. / —
GAS (ROUGH) ` `1�0
/ l
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
0AS (FINAL)
f
TEMP. POLE
GROUT
WATER HEATER
SERVICE
IVINAL INSP. — ri `—`i
�l o�
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. 2 2 �� /
Y I
FRAMING /�D
FINAL INSPa-2(_ f �
e�
ROOFING Nre-'` '2,/5/54
'J V
/ •//
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 317
MESH
%A INSULATIONISOUND C /'
T
FINISH GRADING
FINAL INSPECTION Z ��
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL :d