002325 (SATT)P.O. BOX 1504 No. 0023.25
Building 78-105 CALLE ESTADO
Address 281 Oak H$ LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 75-005
City
- palm
Contractor�rt
Nat.
Address
Zip
City Sam � IZip
State Lic.
& Classif. 138
Arch., Engr.,' -
Designer
Tel.
922603 1. .558-2828
I and L
Tela
City
Lic. # 328
A.P. Number
Legal Description
Project Description JKM W` SPIM i
QR
_ fig€? 5 A
Sq. Ft. � .13� No. No. Dw.
Size - MR. .4209M.. Stories 1'' Units
New 9Add ❑ Alter ❑' Repair ❑ Demolition ❑
Address
Tel.
I hereby affirm that I have a certificate of consent to self -insure, or a' certificate of "
City
_ . . ... . ..
Zip
. . _
State
Lic..#
Policy No. Company
LICENSED CONTRACTOR'S DECLARATION
I hereby.affirm that I am -licensed under provisions of Chapter 9'(commencing with Section
.7000) of Division 3 of therBusiness and Professions Code, and my license is in full force and
effect. .. )c d
❑ Copy is filed.with the city. O Certifiedcopy is hereby furnished.-.
.. ..
.. ... .
• SIGNATURE F 11 f... 1.•"r'% ,4?.f r! I J' r -" DATE
�' -;01NNEWBUILDER DECLARATION
I hereby affirmthatI am exempt from the Contractor's License Law for the following
reason: (Sec. 7031..5, Business and Professions Code: Any city pr 'county which requires a+
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also r:
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's civil penafty 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
do the work, and the structure is not intended or offered for.sale. (Sec. 7044, Bussness 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
or proving that he did not bufld or improve, for the purpose of sale.) - '
❑ 1, as owner of the property, am exclusively contracting' with licensed contractors to con-
• struct the project. (Sec. 7044, Business and Professions Coder 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
Estimated Valuation
CYJ��tD80V�
'
PERMIT- •
AMOUNT
,plan Ghk. De p
'
.t
Plan. Chk. BBI.
/�
.i�i't •�,q
9
Const:91•
��
Mech.
4100
-�a
Electrical -_
�!}!�
Plumbing•
employ any person in any manner so as to become subject to the Workers' Compensation
S.M.I.
5.99
Grading
Driveway Enc.
Date' '" Owner
Date owner
Infrastructure
1..276.,00
ZONE:
�BY:
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. O Certifiedcopy is hereby furnished.-.
TOTAL
2.179•42
CERTIFICATE OF EXEMPTION FROM
REMARKS
.WORKERS' COMPENSATION INSURANCE.
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or -less.) '• ' ' '
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 should become
ZONE:
�BY:
subject to the 'Workers' Compensation provisions 'of 'the Labor Code, you musi'forthwith
MinimumSetback
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
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.
4-21-86
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 ordinarices and state' laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for'inspection purposes "
r`
Validated by:
Signature of applicant �' t l >`.� •• r f_:,t=� r Date
Mailing Address .• `�' r!� ."_ • ..
Validation:
City, State, Zip
A 5 3 2 9
4 2 1
r`%9.42
-1
R
r HARD COPY
f`
J
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EESdglk
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. S0. 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
f4eOUGH PLUMB.
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
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
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
AWERAMING 8 /
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 GOND. SOLAR
SETBACK
ROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
f4eOUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
G fi
O
DUCT WORK
ROCK STORAGE
��,,//
9�FOUND. REINF.�/O ,F
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
1-04 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.
AWERAMING 8 /
FINAL INSP.
Ni !"ROOFING7, �, /
b
Oe TO L4,
I
W
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
G,j.ATHING
MESH
eCeINSULATION/SOUND '00()
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
r—C./-� " '6� 1 jb/ 6 4 pQ•/ -atL