002133 (SATT)44
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address swsz Oak ftm LA QUINTA, CALIFORNIA 92253
Owner ,
Mailing -
Address 95-005 C=ftv ClUb Er.
City IZip ITel.
Contractor
%tIL M=tgagat and Lind
Address
fzil) ITel.
State Lic. I City
& Classif. n83-30 Lic. # 328
Arr•h Fnnr - . - - - dS
Designers
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
70 00) of Division 3 of the Business and Professions Code, and my license is in full force and
- effect. .:
SIGNATURE r�4 DATE
~OWNER -BUILDER DECLARATIONy -
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"LLaw, Chapter 9 (commencing with Section 7000) or
Division 3 of the'Buslness 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 of not more than five hundred dollars (8500). - ,
❑ 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.)
❑ 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
No.. 002133
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
,Legal Description
Project Description TM $I 'Pw 10
Sq. FtDW U-3fl No. No. Dw.
Size MIZ A2A Stories :L Units
Newer; Add ❑ Alter ❑.. Repair ❑ Demolition ❑
Estimated Valuation '85#08840
PERMIT
Plan Chk. bep. .
Plan Chk. Bal. .
Const.
Mech.
Plumbing '
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.)
Polioy No. Company
0 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 (8100) 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., It, 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 it 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 applicant • Date %
Mailing Address
City, State, Zip I
r
HARD COPY
TOTAL
AMOUNT
��J``Lw l3u
1.276.00
REMARKS
PM W IV= PM%f
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
Permit
Issued by:Date
Validated by:
Validation:
A 4 6 3 3
3 10 2179,42 S1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL F
NO. PLUMBING FEES
IST FL. SQ. FT. p
UNITS
TASLAB GRADE 3 3/
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
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
WASH ER(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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
TTTTTT4�THING
������,,,,"
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE MECH.FEE
P_.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACKg./dROUND
PLUMBING G�
UNDERGROUND
A.C. UNIT
COLL. AREA
TASLAB GRADE 3 3/
OUGH PLUMB. L/
BONDING
HEATING (ROUGH)
STORAGE TANK
F FORMS (� �) G
I
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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.
�LzFRAMING 6�,s
FINAL INSP.
91,,1'ROOFING 6 �� G/
rr O Y
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
TTTTTT4�THING
������,,,,"
MESH
NSULATION/SOUND 6
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL
911fK