002129 (SATT)44
P.O. BOX 1504 N O .
Building 78-105 CALLE ESTADO
Address 80-Wl Cak Tme LA QUINTA, CALIFORNIA 92253
Owner
Address 75-00tr5 Cbmtry Cv Ub )rine
CityZip ITel. "
.. '1 Sext 226 568-2US
ress
Zip Tel."
Sam I
State Lic. City
& Classif. 288330 [Lic. # 328
Arch., Engr., ' ' -
Designer
Address Tel.
City Zip State
_. Lic. #
LICENSED C.ONTRACTOR'S DECLARATION
I hereby affirm that I am "licensed under provisions of Chapter 9 (commencing with Section
7000) of Divrision 3 of theBusiness and Professions Code, and my license is in full force and
effect.. t �i ,/ /! ' J/ - -.:;z . /I- -! y
SIGNATURE N Y•. s -� DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from She 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 therefrom, and the bast
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). '
Q 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 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.)
❑ 1 am exempt. under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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.
V 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
Thereby 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 sof this city to enter the above-
mentioned property for inspection,purposes.fl,
Signature of applicant 1 Date
Mailing Address ��.1 l // ir,
City, State, Zip ! r
HARD COPY
002129
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Phi ICST MM i f
BY:
Minimum Setback Distances:
Front Setback from Center Line
1330
Sq. Ft.GAR 424
Size
No. Z No. Dw. 1
Stories Units
New :9 Add ❑
Alter ❑ Repair ❑ Demolition ❑
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 3-30-86 Permit
Validated by:
Estimated Valuation
PERMIT
AMOUNT
i
..Plan Chk: Dep.
"
Plan Chk. Bal.
324,,e
Const.
391.00
Mech.
MAW
Electrical
59.99
Plumbing
87.50
S.M.I.
5.99
Grading
Driveway Enc.
Infrastructure
lip 276.00
TOTAL„ji,4
REMARKS
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 3-30-86 Permit
Validated by:
Validation:
A4b31
3 10 2179,42 Sl
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEF"
NO. PLUMBING FEES
1ST FL. SO. FT. ®
UNITS
TSLAB GRADE
2ND FL. SO. FT.
3ONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT, ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
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.COOL 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.
SQ. FT. ® c
BATH TUB
SPARK ARRESTOR
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
MEOH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBINGy
UNDERGROUND
A.C. UNIT
COLL. AREA
TSLAB GRADE
&IaOUGH PLUMB. (,/ L/
3ONDING
HEATING (ROUGH)
STORAGE TANK
FORMS -/
SEWER OR SEPTIC TANK /
(
UGH WIRING 6 l
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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.
L FRAMING
FINAL INSP.
t.4"
r` _ROOFING Or
vVENTILATION d
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
i
LATHING
MESH
�Q&NSULATIONISOUND S
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIIMITIALS
GARDEN WALL FINAL