001858 (SATT)P.O. BOX 1504. No. 001858
Building 78-105 CALLE ESTADO
Address -3` 8 Mk 'ice LA QUINTA, CALIFORNIA 92253
Owner
Sqmrim ommm BUILDING: TYPE CONST. . OCC. GRP.
Mailing
Address 5-2005 Cftmtry Club rl.'� A.P. Number
City Zip Tel.
peamDeswt 92260 56,8.2028 Legal Description
Contractor Project Description PQ MT NIM 30
x3tiirw-d and mwtgaga
Address, .
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
0 Copy is filed with the city. _ 0.
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 lhg 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 -of this city to enter the above--/
mentioned property for inspection purposes. J
Signature of applicant i ? % Date /!✓ : =Y = .
Mailing Address u.
City, State, Zip 1
HARD COPY
n m0u,
TOTAL
REMARKS _
7t`t it i ti -- X r a xc isa i►s� r We c rig •
N/ i'a3=
WUW
ZONE:
City
Sam
Zip
Tela
Front Setback from Center Line
State Lic.
& Classif.
City
Lic. # 328
1627
Sq. Ft. No.
Size OR. ..424 Stories 1 - '
No. Dw.
Units
Arch., Engr.,
Designer �S00�
New O Add El Alter ❑
Repair ❑ ' Demolition El
Address
291, 15 l AM.
TeL
(714) 544-5317
Issued by:
Date .11-13' 85 Permit
Validated by:
City
costa Mew. .1
Zip
-2626
State
Lic. #
,. LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that.Fam 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.
' r ..
.
SIGNATURE -' I" .!� / 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, 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 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 a civil penalty of not more than five hundred dollars ($500). . ' - .'
❑ 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. 7()44, 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 whobuilds 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
Estimated Valuation qq�yy `
$ 103P,665f60
PERMIT '
AMOUNT
'
-
Plan Chk. Dep.
Plan Ch k. Bal.
COf1St.-
Mech.
Electrical
67.41
Plumbing
87.50
S.M.I.
7. ie
Grading
Driveway Enc.
I f t t
1554 08
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
0 Copy is filed with the city. _ 0.
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 lhg 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 -of this city to enter the above--/
mentioned property for inspection purposes. J
Signature of applicant i ? % Date /!✓ : =Y = .
Mailing Address u.
City, State, Zip 1
HARD COPY
n m0u,
TOTAL
REMARKS _
7t`t it i ti -- X r a xc isa i►s� r We c rig •
N/ i'a3=
WUW
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 .11-13' 85 Permit
Validated by:
Validation:
A327.7- 11 13 255&76• CK
CONSTRUCTION ESTIMATE
1ST FL. SQ. FT. ®
2ND FL.SO. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
NO. ELECTRICAL Elmlik
UNITS
MOBILEHOME SVC.
POWER OUTLET
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
I ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax.valuation
FLOOR DRAIN
MECHANICAL FEES
LAB GRADE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
STORAGE TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
T EWER OR SIIt
LAUNDRY TRAY
AIR HANDLING UNIT CFM
DUCT WORK
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
SO. 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
BOND BEAM
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO.FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE I PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
UND PLU N
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
T EWER OR SIIt
ROUGH WIRING 3
DUCT WORK
ROCK STORAGE
► /4'FOUND. REINF. � 1119511111
F.14-FOUND.
d f
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
STEEL 1 /v/
GAS (FINAL) I�
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_ $
LUMBER GR.
FINAL INSP.
FRAMING r} C]
ovI-
NAL INSP. /G/
ROOFING ?
i) (�
d� 1(
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
l I
FINISH GRADING r l�
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
inaru: i vn a awnw i vnewmm iAw,
GARDEN WALL FINAL
-Tg 31) cY �