002468 (RPL)4
P.O. BOX 1504 No. 002468
Building78-105 CALLE ESTADO
Address 54"_ LA QUINTA, CALIFORNIA 92253
Mailing
Address 7s—ons aRMtM Club I ip
City
Zip
Tel.
pal; Desert
.922G.0
Contractor
. ..
:,Address,
665 GaMM road
City
Zip � 'Tela
LICENSED CONTRACTOR'S DECLARATION"
I hereby of firm that I am l ci ensed_under provi ons of Chaip er,9'(commencing with Section
70 130) of Division 3 of, the Business and.Professions,Code,:and•mylic'ense is`in-full force and
effect. }� i• /` . r`•- :9?
�dm3 �i�;�
Validated by:
State Lic.
City
& Classif. 275796
Lic. #
20000.'0/�
0
PERMIT
kq 320 2;]
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description E PWRE 3 A
69 Sq. Ft.
Size
No. No. Dw.
Stories - Units
Arch., Engr.,
Designer
New IX Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
Rear Setback from Rear Prop.,Line
Side Street Setback from Center Line
City
Zip
State
Lic. #
FINAL DATE
INSPECTOR
LICENSED CONTRACTOR'S DECLARATION"
I hereby of firm that I am l ci ensed_under provi ons of Chaip er,9'(commencing with Section
70 130) of Division 3 of, the Business and.Professions,Code,:and•mylic'ense is`in-full force and
effect. }� i• /` . r`•- :9?
Date 7-21 86;Permit
Validated by:
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, atter, improve, demolish, of 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 or the Business .and Professions Code, or that. he it exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant fora permit
subjects'the applicant to a civil penalty of not more than five hundred dollars ($500): `.
O (, 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.)
❑ 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.) -
❑ I am exempt under Sec. B. 8 P.C. for this reason
Estimated Valuation
20000.'0/�
0
PERMIT
AMOUNT
Plan Chk. Dep.
-
- -
Plan Ch k. Bal.
•! ��yy
9Ao36
CDnst..Yii
r�w�
a rJ{I
Ivlech.
iyicr�
Electrical
_ g }�
'71.91�
Plumbing
8 9p �+.
J�.00
S.M.I. -
•�
1.37
Grading
Driveway Enc.
Date owner
Infrastructure
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 Certified copy is hereby furnished.
CERTIFICATE OFEXEMPTIONFROM
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 any person in any manner so as to become subject to the'Workers' Compensation
Laws of California.
TOTAL
290.x.9
REMARKS
'
- -
'Date Owner
NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become
subjectto' 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 innspectior purposes.
Signature of applicant 91 �f.F� rr~� p
Mailing Address f
City, State, Zip r
HARD COPY
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 7-21 86;Permit
Validated by:
Validation:
A 6 0 8 6
% 3U 29u1.9 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. $
2ND FL. � SQ. FT.
POR. t SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT. ®
WALL SQ. FT. p
i
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
I
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (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,TEMIPERM
LAVATORY
HEATING SYSTEM I FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
J
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
I,
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE j PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
I
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION I
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR I
GAR. FIREWALL f
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
I
FINAL INSPECTION
CERT. OCC.
FENCE FINAL -
I vn'b WUNA I untbnNl I IALb.
GARDEN WALL FINAL