002596 (SFD)414'
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54—U7 OF& HM LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75" 15 Cntr y,�,wa?
City Zip Tel.
Palm De =t 22i 568-2828
Contractor
. Address: .
City
State Lic. City
& Classif. 2$$130 Lic. # 328
Arch.,- Engr'.,'
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'$ DECLARATION ,
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect..
SIGNATURE DATE
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, alter. 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 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 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): '
Q 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 for 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 for the purpose of sale.) .
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 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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. I I
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 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 of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
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 inspection purposes.
Signature of applicant Date
Mailing Address
City, Slate, Zip
HARD COPY
UILDING: TYPE CONST. OCC: GRP.
.P. Number
egal Description
roject Description FGA. W PHAW 12 A
Plan 2p
REMARKS
ZONE:
BY:
Minimum Setback Distances:
DW 1548
Sft. 424 No.
Size Stories
No. Dw.
Units
New ❑X, Add ❑ Alter ❑
Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 9-3 86 Permit
Validated by:
Validation:
Estimated Valuation
97.623..00
A 6 4 2 7
-.PERMIT
r.
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
352.05
Const.
427.00
Mech.
34.00
Electrical
85.44
Plumbing
87.50
S.M.I.
6.83
Grading
Driveway Enc.
Infrastructure
a464,35
TOTAL
2,437.17
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 9-3 86 Permit
Validated by:
Validation:
A 6 4 2 7
9 30 437.1.7 CPQ
CONSTRUCTION ESTIMATE Adillik
NO. ELECTRICAL FE
NO. PLUMBING FEES
1ST FL. SQ. FT. g $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
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
7—Gd-SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
IV-
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROCK STORAGE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
C;7
7O1
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.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
WATER SYSTEM
SQ.FT.GAR ® lAc
HOUSE SEWER
GRADING
cu. yd.
$ plus x$
_$
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 PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
7—Gd-SLAB GRADE
C l
U/—ROUGH PLUMB.i(I(?
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
FL,,eSEWEFt OR SEPT
IV-
H.✓ROUGH WIRING j2 /_
Y
DUCT WORK
ROCK STORAGE
,I/6 FOUND. REINF. Q_(, _5r0
� AS (ROUGH)'
C;7
7O1
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL/
tea'
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
4114NAL INSP. O.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR,
vt/FINAL INSP. f� a ?
1/4FRAMING i2 G -
'FINAL INSP. (n`
r
ROOFING0
11 Lr` ��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
ILL/ LATHING
MESH
YL` INSULATION/SOUND (1 v�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
rL, i uM"J Ammmi4I umr*imI I IAUk
GARDEN WALL FINAL