002427 (RPL)TAt�t
•44
��.
P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 54-814 Oak TtM LA QUINTA, CALIFORNIA 92253
Owner 4...
er F. `S CkWJ
002427
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address
A.P. Number
City
Zip
Tel.
La oJifta
.92225.3
f_606S.
Legal Description
Project Description
Contractor
Address+..
l.
City ..
flim Des=t
Zip
9225
Tela
State Lic.
City
& Classif. t
Lic. #
Sq. Ft.
Size
No. No. Dw.
Stories- - Units
Arch., Engr., .. .
Designer
New ❑g Add ❑
Alter ❑ 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 wilh'Section
7000) of Division 3 of the Business, and Professions Code, and my license is in full force.and
effect..
SIGNATURE DATES
' 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 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.
DiGision 3 of the Business and Professions Code, or thathe is exempt therefrom, grid the basis '
' for the alleged exemption. Any violation of Section 7031.5 by 'any . applicant for a .permit
- subjects the applicant to a civil penally 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. 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 or completion, the owner -builder will have the burden
..of proving that he did not build or improve for the purpose of sale.)
Estimated Valuation
Ey' 91,200i.00
-PERMIT
•- AMOUNT
•s
:Plan. Chk. Dep.
• .
Plan Chk. Bal.
.52.32,
Const.
80.50
Mech. '-
!
d•�.*
_
Electrical
1"" 12.09
Plumbing
,
0 I, as owner of the property, am exclusively contracting with licensed contractors to con-
strucl 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.).
O 1. am exempt under Sec. B. & P.C. for this reason
S.M.I.
-
-
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
gopy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
173.49
CERTIFICATE OF EXEMPTION FROM
WORKERS' COM PENSATION.INSU RANCE
REMARKS
_
(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' i,e a •! (Owner :, II -K , , Y%7 1 tt ,!'%`r/-* � :• l ,-'t ' f 7! r; + �`
NOTICEITO APPLICANT: If, after .making this Certificate' of Exemption you should -become-
' subject to the Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
ZONE:. BY:
,Minimum SetbackDistances: -
Front Setback.from Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performanceof the
- work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Street Setback from Center Line
Side Setback from Property Line '
Lender's Name
FINAL DATE
Issued' by:
Validated by:
Validation:
A5875.
INSPECTOR
6-24"+O-96
Date Permit .
b 27 17.49 CK
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 sof this city to enter the above-
mentioned property for inspection purposes. {! p
Signature of applicant. �° - - . , . r' . / .."k ✓ f� Date--±
Mailing Addresst v r
City, State, Zip J. a �; ... i ✓ `A , ♦ ! .
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. p $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
t—ROUGH
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOB]LEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.
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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
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.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/4c
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 6
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.[�QONDING
t—ROUGH
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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 SIGNATURESIINITIALS,
GARDEN WALL FINAL