002158 (SATT)%UY/
44
P.O. BOX 1504 No. 002158
Building 78-105 CALLE ESTADO
Address 84"697 GA Wee LA QUINTA, CALIFORNIA 92253
:> Let Quinta ompww
Mailing
Address - c.� Dries
City Zip `• Tel.
P"am Daswt 92260 %8-2828
Contractor
IbU and Land
Address
City - IZip 'I Tel.
State Lic. I City
& Classif. 2$$130 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
effect. N. .
SIGNATURE, 4 ,y' ,'f "..�ti __..� °' i DATE
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 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 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 ($500).
❑ 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. andwhocontracts 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
Date Owner
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' 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, I shall not
employany 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 .
Ihereby 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_'
Mailing Address
City, State, Zip r �"
HARD COPY
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description!
BY:
Minimum Setback
Distances:
Front Setback from Center Line
1 1330
Sq. Ft. 424 No. 1 No. Dw. 11
Size Stories Units
New :7 Add ❑ Alter ❑ Repair ❑
Demolition ❑'
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 3-10-86 Permit
Validated by:
Estimated Valuation eeC �y� pp
Validation:
PERMIT.-
AMOUNT
Plan Chk. Dep.
3 10 L179.42 Sl
Plan Chk. Bal,
324.94
Const. _
391.00
Meoh.
3440
Electrical
59.99
Plumbing
8740
S.M.I..
Grading
Driveway Enc.
Infrastructure
1,276.00
TOTAL
2.179.42
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 3-10-86 Permit
Validated by:
Validation:
A 4 6 3 8
3 10 L179.42 Sl
CONSTRUCTION ESTIMATE y
NO. ELECTRICAL FEF"'
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SO 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
FRAMING AA 4
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1114 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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
JLa6OUND PLUMBING ft
,b UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
tboauGH PLUMB. 3 6
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
FEWER OR SEPTI
%
♦GH WIRING -717 /
f
DUCT WORK
ROCK STORAGE
FOUND. REINF. i /�/
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.
FRAMING AA 4
FINAL INSP.
ROOFING �Fj
(�
.
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�v
LATHING -7 J A?k
MESH
JJSULATION/SOUND 7 8K
I
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
uR y wotll 7/ r /;w �,�