002433 (RPL)A -t- / .2 S ;-1 6 0 44
-so'? �*
o'?�*
P.O. BOX 1504 No.. • 002433
Building 78-105 CALLE ESTADO
Address 80-725 Oak TkM LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address Tri• M anmitTv Clilb D,_
City Zip Tel.
Contractor
• a s rev : ♦ry
ty lZip
BUILDING: TYPE CONST. OCC: GRP.,
A.P. Number
Legal Description
Project Description
l:1414 dl� wttc.1 �♦ mss. 'i-.
State Lic. w
City
Minimum Setback Distances:
& Classif. 2757%
Lic. # 69
Sq. Ft.
No. No. Dw.
Side Street Setback from Center Line
Size
Stories Units
Arch., Engr., � -
INSPECTOR
Issued by:
Designer
New CR Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
A5873
6 27 9 a 1 9 CK
City
Zip
State
_ _ ....
Lic. #
LICENSED CONTRACTOR'S DECLARATION
_
I hereby affirm that I em licensed under provisions of,Cti p er 9 (commencing with Section
7000) of Division 3 of,thee Business and=Pfofessions'Code," and my license is in full force and
effect..t
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following+
reason: (Sec. 7031.5,Business and Professions Code: Anycity 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
PERMIT
a
-
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
•r.
' Division 3 of the Business'and Professions Code, or that. he is exempt therefrom, and the basis
for the Any Section 7031.5 by 'any for
Plan Chk. Dep.
-
alleged exemption. violation of applicant a permit
' subjects the applicant to's civil penalty,of not more than five hundred dollars ($500).
Plan Chk. a.
B
9A7l
• ❑ 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
COnSt
47j�V�j{}.
License Law does not apply to an owner of. property who
._ Professions Code: The Contractor's LicenseS
.
+ ,
builds or improves thereon and who does such work himself or through his own employees,
Mach.
25.00
.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
Electrical
.. _
7,� ;�
of proving that he did not build or improve for the purpose of sale.)
w ,
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
q
i0�0V
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.)
Grading
.37
O I am exempt under Sec.• B. & P.C. for this reason
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. ❑ Certified copy.is hereby furnished.
TOTAL
290.19
_
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, 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
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 sof this city, to enter the above-
mentioned property for inspection purposes ✓
jY
Signature of applicant /� ""�� +'"Date -
Mailing Address /f
City, State, Zip
HARD COPY
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 6--25-86Permit
Validated by:
Validation:
A5873
6 27 9 a 1 9 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. S0. FT.
BONDING
YARD SPKLR SYSTEM
POR. S0. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. @
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. 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
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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./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
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 SIGNATURES/INIlIALS.
GARDEN WALL FINAL