002281 (SATT)Building 542-005 U
Address
Owner
simrim o
Address 75-005 Q=ntrV
City I Zip
ntractor
Tel.
Aaaress
sam
City
Zip Tela
State Lic. I City
& Classif. o Lic. #
Arch., Engr.,
Designer
Address Tel.
I
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City Zip State
Lic. #
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, and my license is in full force and
effect... �,� ,� s°
i,'OWNER•BUILDER DECLARATION
I hereby affirm that I am exempt(from the Contractor's License Law for the following
reason: IjSec. 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 thathe is exempttherefrom, and the basis .
for the alleged exemption. Any' violation of Section 7031.5 by 'any applicant for - a permit
subjects the applicant to a civibpenalty of not more than five hundred dollars ($500).
p 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. ti 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. 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 i1 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 sof this city to enter the above-
mentioned
bovementioned property for, inspection purposes.
Signature of applicant_ / Date p e4 E "�
Mailing Address
City, State, Zip f ar
v y
r� 1
HARD COPY
No. 002281
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description PM MW FM 3
OR
NOW 3A
D 1627
Sq. Ft. E42,4No. No. Dw. 1
Size Stories - Units
New E Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep..
Plan Chk. Bal.
364.19
Const.
443.53
Mech.
34.00
Electrical
57.41
Plumbing
87.50
S.M:I:.
Date 4`10-86Permit
Grading
Driveway Enc.
Validation:
Infrastructure
1,554.38
4 10 255&76 CK
TOTAL
. i
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 4`10-86Permit
Validated by:
Validation:
A5188
4 10 255&76 CK
CONSTRUCTION ESTIMATE t
N0. ELECTRICAL FEES'""
N0. PLUMBING FEES
IST FL. SQ. FT. a $
2ND FL. SQ. FT. qp
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. Q. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
,F,AS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
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
I
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.I
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
FIRE ZONE ROOFING 1
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
SETBACKok
01
ROUND PLUMBING,/ 7
UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE /G/
4f0UGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR
RO? IRING ' (
DUCT WORK
ROCK STORAGE
�j,rFOUND. REINF. !�
,F,AS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL t
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING ��� ?I �•
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING 1
FIREPLACE
SPARK ARRESTOR -
GAR. FIREWALL
LATHING ! %C
MESH
PlSULATION/SOUND* l5*d
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL