002113 (SATT)• I
4
4
P.O. BOX 1504 No.
Building 78-105 CALLE ESTADO
Address 90-339 Oak T9 LA QUINTA, CALIFORNIA 92253
Owner _ ..
Mailing
Address 75-005 0=*ry Club ttY W
City Zip Tel.
Pain Des"It .92260 568-2M
Contractor
7�
.Address
City tZip ITel.
Sam
State Lic. City
& Classif. 2ssim Lic. # 328
Arch., Engr.
Designer
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
SIGNATURE • V - DATE
7 r ' 01NNER-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
-" Division 3 of the Business and Professions,Code, or that. he is exempt "therefiom, 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 oAnot 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 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 Codeu 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.)
❑ 1 am exempt.under.Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
hereby affirm that I'have'a certificate of consent to self -insure, or a certificate of '.
Worker's Compensation Insurance, or a certified copy'lhereof. (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 cartify'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 applicant ` ' �: Date
Mailing Address i'1
City, State, Zip t
HARD COPY
002113
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description P(;;L 7 4 O
Sq. Ft. 1918
Size G .424
New Q Add ❑
No.
Stories
No. Dw.
Units - - I
Alter ❑ Repair ❑ Demolition ❑
atimated Valuation
9 .ib; ..
PERMIT
Plan Chk. Dep...
25
Plan Chk. Bal.
ZONE:
Const.
Minimum Setback Distances:
Mech:
Front Setback from Center.Line
Electrical
Rear Setback from Rear Prop. Line
Plumbing
Side Street Setback from Center Line
S.M.I.
Side Setback from Property Line
Grading
INSPECTOR
Driveway Enc.
Date 3-5-86 Permit
Infrastructure
Validation:
A45%2
3 6 2641,56 it
TOTAL
AMOUNT
145.64
485.50
34.00
74;.65
'87.50
9.30
REMARKS
V111 C. Mn M% W V PAS' (W IMS 7WArP
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%2
3 6 2641,56 it
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. @ $
UNITS
SLAB GRADE 3�i �G N
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT S r%� �j
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
WASH ER(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,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/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
p
LATHING //Z7 ,E�A
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
1111 f. //
SETBACK 31111A-
GR*Z PLUMBING ��
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 3�i �G N
(L�cROUGH PLUMB. S//�/j
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
`SEWER OR SEPTIC
/I kOUGH WIRING S N fib
O
DUCT WORK
ROCK STORAGE
FOUND. REINF. 311BG 107y
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL V-2 7
GAS (FINAL)
TEMP. POLE
GROUT S r%� �j
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAMS N
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
FINAL INSP.
FRAMING 57/, 6 1, (r
/
FINAL INSP.
ROOFING 6 y/&
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
p
LATHING //Z7 ,E�A
MESH
INSULATIONISOUNDS
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL _
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL
s/A?/ff' X/L