002003 (TT)Building
Address 49-421 ;h7WJ.a CbregM
Owner
Ian&fr%C land ®D•
Mailing
Address F•®.B= low
City p
Ia .� Zi92253
Contractor
im $1^�
Address
- City
State Lic.
& Classif.. .
Arch., Engr:,
Designer
Address
•
QUM
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. CO3
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
345-,2,858 Legal Description
Project Description 'An Hary Frd lErs -for
.. . Zip .. . . Tel.. . .
C& 93395 (7.4) 674 -
City
Lic. #
Tel.
1 11.61 }! 451
Sq. Ft. No.
Size - Stories
.2 0 101 x 281
No. Dw
Units
I New R Add ❑ Alter ❑ Repair O Demolition ❑
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.
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Coder Any city or county which requires a '
Estimated ValuationI
PERMIT
'
AMOUNT
permit to construct, alter, improve, demolish, or repair any structure,' prior to its issuance also
requires the applicant for such permit to fife a signed. statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9.•(commencing with Section 7000) of
Plan Chk. Dep..
•. -
Division 3 of the 'Business and Professions Code, or thatfie is'exempt theiefrbm, *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 lheirdsole compensation, will
Plan Chk. Bal.
Const.
400.00
'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.
proves thereon and who does such work himself or through his own employees,
builds or improves
provided that such improvements are not intended or offered for sale.. If,. however, the building,
Electrical
�j�y q
6A•0N
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.) -
Plumbing
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
strucl-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.W.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)-
0 1 am exempt under Sec. B. & P.C. for -this reason
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.)
Policy No: Company
❑ Copy is filed with the city. . 11 Certified copy is hereby furnished.
TOTAL
424 • W
CERTIFICATE OF EXEMPTION FROM
WORKERS'. COMPENSATION INSURANCE
REMARKS
'
(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 Wthe Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY: -
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
FINAL DATE
INSPECTOR
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..
Signature of applicant rf s; Date r
Issued by:
Validated by:
Date 1-17-86 Permit
Mailing Address
Validation:
A588 6
1 .1.7
4 2 4' 0 0 Ck
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING -EES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SD. FT.
SQ. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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 a
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 APPJEQUIP.
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
INSULATIONISOUND
FINISH GRADING
L f+�FINAL INSPECTION G
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL