001769 (RPL)44
P.O. BOX 1504 No. 401769
Building78-105 CALLE ESTADO
Address �.5_657 Oak RM LA QUINTA, CALIFORNIA 92253
Mailing
Address 75-005 Oxmb
City Zip
Contractor
.-Address
.City Zip
Cathadml Citid 92234
State Lic.
& Classif. C 53 2757%
Arch., Engr.;
Designer
Address
Tel.
32$"'2681
City
Lic. # 69
Tel.
City Zip State
Lica #
LICENSED CONTRACT,OR'S•DECLARATIQN_ '
I hereby affirm that I am licensed under provisions -:0f Chapt i 9 (commencing with Section
7000)0f Division 3,o`f the BUsiness4 nd Professions Code, andel my license is in full force and'
effect.'. _ .S.
_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.
peimit to construct, alter, improve, demolish, or repair any structure, prior to -its -issuance .also
,-requires the applicant for such permit to rile a signed statement that -he is -licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with -Section 1000) 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). - - " '
❑ 1, 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 ofproperty who
builds or improves thereon and who does such work. himself or through his own employees,
provided thaf' 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. 704.4, 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.)
O 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. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby.fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Whir one hundred dollars ($100) valuation
or less.)•
I certify that in the performance of th0 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 it 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 taws relating to building
construction, and hereby authorize representatives -ofdlhis_city ,to enter the above
mentioned property for inspection'purposes:V' ' f
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
BUILDING: TYPE CONST. • OCC: GRP.
A.P. Number
Legal Description
.... r 1
Project Description
.x..spa
REMARKS '^ --
ZONE:
BY:
Sq. Ft. No.
Size Stories.
No. Dw.
Units
New:9 Add ❑ Alter ❑
Repair ❑ Demolition ❑
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
-
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 10-28-85Permit
Estimated Valuation g 10,c .v
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
10 28 j.8622 Sl
Const.
269.%
Mech.
17.50
Electrical
12.00
Plumbing
14.00
S.M.I.
Grading
Driveway Enc.,
Infrastructure
TOTAL
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 10-28-85Permit
Validated by:
Validation:
A 2 9 9 8
10 28 j.8622 Sl
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 SQ. FT.
SQ FJ ®
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
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
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 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 ® 11/4 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= 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
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL