002115 (SATT).. 11 0 441. 0
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 80-453 Oak 'MIMS LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75-005 OMMt3:Y'Otb D'.
City lZip ITel.
568-2828
Contractor
w.,a mortzmm filad L
Address.
City � Zip Tela
sam
State Lic. City
& Classif. 288130 Lic. #
Arch., Engr.;'
-Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTO.R'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. ... '• . % �� ° +,. "_ {i .)r _
10,
No. 002115
BUILDING: TYPECONST. OCC: GRP.
A.P. Number
Legal Description
Project Description M M KIM ft90 R
LOW" .L71A
Sq. Ft.(Va • 424 No. 1 No. Dw. .
Size Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
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 permitito file a signed statementthat he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section .7000) of
Estimated Valuation .. �
PERMIT
Division 3 of the Business and Professions Code, or. that. he is exempt therefrom, and the basis
for the alleged exemption.. Anyfviolation of Section 7031.5 by any applicant for a permit
Plan Chk. Dep..
subjects the applicant to a civil.penalty of not more than five hundred dollars ($500). -
O I, as owner of. the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
Const.
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
Mech.
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
Electrical'
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.)
Plumbing
❑ 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 or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I 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
❑ Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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 the 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 Ownei-
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 tof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant � �.1/ �'=,+� 1rF�...,..-% Date._�� �
Mailing Address 1 �`% _' .F -.r `
City, State, Zip • r
HARD COPY
TOTAL
665.50
qq�pp
AMOUNT
250.; 00 "
145.60
485.5€
34.00
74.69
87.50
Q.30
1,805.97
REMARKS
-PrAllt, AWN) SPA ' PARS` iW q5= P MT
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:
A4572
3 6 2647:56 it
CONSTRUCTION ESTIMATE
s NO. ELECTRICAL' EES-' 1
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
1 `( LAB GRADE S 7�
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
DRAINAGE PIPING
WALL SQ. FT.
DUCT WORK
DRINKING FOUNTAIN
SQ. FT.
GAS (ROUGH)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REIN F. STEEL ��
FLOOR DRAIN
MECHANICAL FEES
TEMP. POLE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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
TSN SETBACK 3
ROUND PLUMBING
`1 /
UNDERGROUND
A.C. UNIT
COLL. AREA
1 `( LAB GRADE S 7�
n 1daOUGH PLUMB. S /
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
h EWER OR SE 1 A
2/8'UGH WIRING
5 /y
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REIN F. STEEL ��
GAS (FINAL)
TEMP. POLE
GROUT f��Jj �6
/
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM /.27. �6' �L
!—
WATER SYSTEM
GRADING
cu. yd.
$ plus—x$—=s
LUMBER GR.
FINAL INSP.
FRAMING ��� j2k
FINAL INSP.
ROOFING U%�O�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
/-I JSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL
J�71— r f/ �1;yieb /z"K