002112 (SATT)1A
P.O. BOX 1504 No. .002112
Building78-105 CALLE ESTADO
Address 80-3n 0t*' LA QUINTA, CALIFORNIA 92253
Ownt?r
Mailing
Address
City ZipTel.
. Palm Desext 92M . 56£-2
Contractor
.4=t4Wft and L=d
Address :..
Sam
City lZip Tel.
State Lic. I City
& Classif. Lic. #
-"Arch., Engr.,
Designer
Address Tel.
City Zip State
Lica#
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. 4.
SIGNATURE F - DATE
` OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason:..(Sec. 703,1.5,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 permft.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
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'ofnot 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 of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) -
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Coder 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 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 laws relating to building
construction, and hereby authorize representatives of this city to enter the 'above- '
mentioned property for inspection purposes.
Signature of applican A r f ` �: y, �_�. �" Date
Mailing Address / iA,j
City, State, Zip
r /
f HARD COPY
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number.
Legal Description
Project Description W-711, %M -x' PTJW 4 t!'
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft. EM 1918
Size CAR424 • •
No.
Stories i,
No. Dw.
Units
NewjEl Add ❑
Alter ❑.
Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
Issued by:
Date 3-5-86 Permit
Validated by:
Validation:
A45%Z
3 b 264L56 it
Estimated Valuation
Y 203485.50
.PERMIT
,L
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
145.6€3
Const.
485.50
Mech.
34.134
Electrical
74.69
Plumbing
87.50
S.M.I.
8,30
Grading
Driveway Enc.
Infrastructure
1,805.97
TOTAL
2,891.56
1 2,,641.56
REMARKS .
Wi
AIM SPA. WM Rtli•,.1. TM PM=
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 3-5-86 Permit
Validated by:
Validation:
A45%Z
3 b 264L56 it
CONSTRUCTION ESTIMATE .,
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. p $
UNITS
SLAB GRADE 3
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®_
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUTWATER
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
LAUNDRYTRAY
AIR HANDLING UNIT CFM
,
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING arlxer "el—
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE MEC:-I.FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK ///� �/r
(((�/07
ROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 3
eGUUGH PLUMB�1 �
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
/-�9EWER OR SEPT Y
1�0601-1 WIRING f�Iy
DUCT WORK
ROCK STORAGE
FOUND. REINF. ]� el i- �/
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL F7
GAS (FINAL)
TEMP. POLE
GROUTWATER
HEATER
SERVICE
FINAL INSP.
BOND BEAM 2 7
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING6 e/
'
FINAL INSP.
ROOFING 6 X17 ��'
7
,
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING arlxer "el—
MESH
INSULATIONISOUNDS
1
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINI-IALS
GARDEN WALL FINAL :d