002458 (RPL)Building 80-459 OakAddress
Owner
smud :
Mailing
Address
City Zip
Contractor
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Address
Sam
• City Zip- - Tel..
& Classif. 208130
Arch., Engr.,
Designer
Address
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
filly
Lic. # - 328
Tel.
BUILDING: 'TYPE CONST. OCC: GRP.
A.P. Number.
Legal. Description
Project Description VM TAW $lam 9 A
Sq. Ft. No. No. Dw.
Size -•- Stories Units
New ❑A Add ❑ Alter ❑- Repair ❑
City Zip State tl.A �. 111 ..., . :
Demolition ❑
CERTIFICATE OF EXEMPTION FROM
REMARKS "
Lic. #
WORKERS' COMPENSATION INSURANCE
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that Fam 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. ✓ ✓ �� 3s – fr .t / % J av
SIGNATURE `"' "' _ DATE
• or less.)
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
Estimated .Valuation
reason: •(Sec. 7031.5,Busfness and Professions Code:. Any city or county which requires a
permit to construct, alter, improve, demolish;r or repair any. structure, prior to its issuance also
requires the applicant for. such permit to rile a -signed statement that he-is:licensed pursuant to
-
PERMIT -
' ._the provisions of the Contractor's License Law, Chapter,9 (commencing with Section 7000) of
Division 3 of the Business and. Professioris 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
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.
C6r1st.
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 's sold within one year of completion, the owner -builder will have the burden
of proving that he did not build orimprove 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 of property who builds or improves thereon, and who contracts for
S.M:I: • -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
• O 1 am exempt under Sec.. B. 8 P.C.- for this reason
Grading
Driveway Enc.
Rear Setback from.Rear.Prop. Line
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that there is a construction lending agency for the performance of the
I hereby affirm -that I'have a'certificate of consent to self -insure, or a certificate of '
work for which this permit is issued. (Sec. 3097, Civil Code.)'
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Side Setback from Property Line
Policy No. Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
Lender's Address
TOTAL
INSPECTOR
Demolition ❑
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 the work for which this permit is issued,'1 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
comply with such provisions or this permit shall be deemed revoked.
.Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from.Rear.Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line'
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.)'
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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
7-1&-86
read this application and state that the above information is correct.
Issued by:
Date Permit
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;
Validated by:
Signature /i �. Lof
of applicant .• , Date
Mailing Address t..v
Validation:
City, State, Zip
A5.979
7 17 225L Ck
nwrry wrr I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EOU1P.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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 TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOU1P.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL