002048 (BLCK)P.O. BOX 1504 No, 002048
Building 78-105 CALLE ESTADO
Address U-T_'�•�i Q-Afftno tPINWrAm wvol LA QUINTA, CALIFORNIA 92253
Owner
Cb mew BUILDING: TYPE CONST. OCC: GRP;.. '
Mailing '
Address PisIN A.P. Number
City Zip Tel.
Legal Description
Contractor Project Description PM TWT OJI196t.
Address
1 e .2 A - ChaMiOnS- �ttwalls
City Zip Zip. Tel'.
t - and tew priv ► waUs.
State Lic. City
& Classif. Lic.# S Ft. No. No. Dw.
SQ Stories Units
Arch:;•Engr:, ..:. .. :!
-Designer- NewO Add El Alter El Repair ❑ .: Demolition ❑ _
Address • Tel. �•
City Zip State
'Lic. #.. -
LICENSED CONTRACTOR'S DECLARATION
I hereby 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
.a
SIGNATURE % t - ice' DATE - - -
� OWNER -BUILDER DECLARATION
I hereby affirmthatI am exempt from.lhe Contractor's License Law for the following E$tlmated Valuation -
reason.: (Sep. 703J.5,Business avid Professions Code: Any city•.or -county which requires a •-�--+�p��•�{% ,
permit to construct, alter, improveh demolish, -or repair any structure, prior. to its issuance also
AMOUNT .
requires the applicant for such petmit•to file a signed.statement thathe is licensed pursuant to PERMIT '
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 9000) of
th•:r
Division 3 of'e 90'siness'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 Plant Chk. Dep.
' subjects the applicant to a civil penalty of -not more thanfive hundred dollars ($500).' Plan ChkBaI_ 8 / 7,G '•
❑ I, as owner of the property, :or my employees with wages . .. as their sole compensation, will - 4 ii
do the work, and the structure is not intended or offered for sale. (Sec: 7044, Buisness and, Const.'104.50
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.
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 (hat, he did not build or•improve for the purpose or sale.)b-1, as as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's Lioense Law
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. •+ v
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
.
0.1 -am exemptunder.Sec. B. &• P.C. for this -reason - Grading -
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby' affirm that t 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.
TOTAL 173.37
CERTIFICATE OF EXEMPTION FROM REMARKS.
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 ZONE: BY: -
subject to the Workers' Compensation provisions of the Labor Code, you must .forthwith ..Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked:
Front Setback from Center.Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line -
Lender's Name
Lender's Address
This is a'building permit when properly filled out, signed and validated,'and is subject to FINAL DATE INSPECTOR
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. Issued by:- Date 2-48-86 6 Permit
I agree to comply'witli 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. Validated by:
1 %
V rt > rp
Signature of applicant: A - f Date
Mailing Address ;}� r1 -' Validation:
City, State, Zip fi '
r �` A4287 2 18 13,37 Sl
E HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IKITCHEN 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
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 —ANK
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
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUREWINITIALS,
GARDEN WALL FINAL