001913 (RPL)C& 44. 0
tyx a "�.,
Building
Address 5457 Ck b
Owner
Mailing
Address 75-41firi CV- mtr
City I Zip
Contractor
t t+�
Address
68-465, Per= Ad.
City Izip Tel.
-
State Lic.
& Classif: fF
'Arch., Engr.,'
.Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 001913
BUILDING: TYPE CONST. OCC: GRP.
A.P..Number
Legal Description
Project. Description
City
Lic. # &� Sq. Ft. No. No. Dw.
Size Stories Units
I New QAdd ❑ Alter ❑ Repair ❑- Demolition ❑
Tel.
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. O 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 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
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 gLws'relating to building
construction, and hereby :authorize representatives' got this, city to -enter the above-
mentioned
bovementioned property for inspection purposes -
Signature of applicant #�/ :.� • 'A Date
Mailing Address
City, State, Zip
HARD COPY
Infrastructure
TOTAL 0117 4n
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 12-3-.85 Permit
Validated by:
Validation:
A 5 5 0 5 12 9 217,40 CK
City
Zip
State
Lic..#
LICENSED CONTRACTOR'S DECLARATION
y
_
I herebyy affirm that loam Iicgnsecl under provisions'oV( hapter'9 (commencing with Section
7000) o�Division 3cof'the'Bu'sine.,ssss grid Professions ,Code; and:my'licensa is in full force and
;
effect, i' � �.� i fl —� ✓ l L ^ J `.S S
SIGNATURE- -- - DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
13.000.00
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 lo'its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
- -
PERMIT
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section '7000) of
Division3 of the Business and Professions Code; or that. he is. exempt therefrom, and the basis
for Any Section 7031.5 by 'any 'for
Plan.Chk. Dep.
the. alleged exemption. violation of applicant a permit
subjects the applicant to a'civil penalty of not more than five hundred dollars ($500).
.
Plan Chk. Bal.
02
❑ Ias owner of the property, or my employees with wages as their sole compensation, will
a
do .ihe work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
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,
Mech.`J�R�'
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
Electrical
'
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-
Plumbing
14 _00
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
S.M.L... '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)- -
Grading
❑ 1 am exempt under Sec..B. B. & P.C. for this reason
Driveway Enc.
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. O 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 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
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 gLws'relating to building
construction, and hereby :authorize representatives' got this, city to -enter the above-
mentioned
bovementioned property for inspection purposes -
Signature of applicant #�/ :.� • 'A Date
Mailing Address
City, State, Zip
HARD COPY
Infrastructure
TOTAL 0117 4n
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 12-3-.85 Permit
Validated by:
Validation:
A 5 5 0 5 12 9 217,40 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
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/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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 PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
/
W4h"o �3/3� f(`�
v
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
I1415FEGI UN'S WUNA 1 UNE511141 T IALS_
GARDEN WALL FINAL