05362 (AR)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address k1 _011in dTJMTnh n'ftD SPA V LA QUINTA, CALIFORNIA 92253
MCP,ALL PLATT
Mailing
Address SAM
City .Lr* pA Q U�Y �jINTA Zip
Contractor
Address
City lZip I Tela
State Lic.I City
& Classif. Lic. #
Designer
Address Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby afffnn that 1 am licensed under provisions of Chapter 9 (commencing with Section
70 Of Div -cion 3 of the Business and Professions Code, and my license is in full force and
effect
SIGNATURE DATE
OWNEWBUILDER DECLARATION
1 hereby afiom that 1 am exempt from the Contractors License Law for the following
reason (Sec 7031-5,0usiness and Ploressions Code: Any city or county which requires a
penia to construct ata rr uove, demnoish. or repair any structure, prior to its issuance also
regimes the appiea I for such permit to fie a signed statement that he is licensed pursuant to
the provisions of the C nt ach" license law, Chapter 9 (commencing with Section 7000) of
.vision 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 app- I to a ciW penalry of not more than five hundred dollars ($500).
❑ 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 Lxxmo law does not apply to an owner of property who
tie7ds or improves thereon and who does such work himseff or through his own employees,
provided that such irprovernents are not intended or offered for sale. If, however, the building
of irprovemerd is sold within ane year of completion, the owner -builder will have the burden
of provirg that he did not bull or irprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the projecL (Sec 7044, tress and Professions Code: The Contractor's License Law
does not appy to an owner of property who builds of improves thereon, and who contracts for
such projects with a conbacton(s) Ecersed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec R & P.C. for this reason
Date-, .<<.. 1, Owner
WORKERS COMPENSATION DECLARATION
1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workees 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.
CENFU`1CATE OF EXEMPTION FROM
WORKEW COMPENSATION INSURANCE
(This sew- need not be conpieted 9 the penia is for one hundred dollars ($100) valuation
or less.)
certify that in the performance of tfp 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 /►°/'r1�°� "e -
N0710E 70 APPLICANT : t, °after mating" Ia&'-Gertilicate`o! Exemption you should become
subject to the Wmkws' Compensation Provisions of the Labor Code, you must forthwith
comply with such proomors or this perms shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affimn that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civd Code.)
Lenders Name
Lenders Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspected for 180 days.
I certify that 1 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 arthame representatives -of this city to enter the above-
mentioned property for inspection purposes
Signature of
Mailing Add
City, State,
No. 05362.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 771.-1n,t:.nnq_.
Legal Description le%* Q. 101r ZA,>r. _ el1gln5s
Project Description "VVf Allyl nn= a MAn "^nw vfrr
MST= It ASPHALT SREME
O'CL I .`G PAPA & ADDM,1
1/2" SMTHING SHT WTH. SCREWS
Sq. Ft.
Size
No. No. Dw.
Stories Units
rNew ❑ Add ❑
Alter ❑ Repair ❑ . Demolition ❑
Estimated Valuation
non
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
54.00
Mech.
Electrical
Plumbing
S.M.I.
.21
Grading
Driveway Enc.
Infrastructure
TOTAL
)
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 2/15/99 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
r
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL' SQ. FT.
=$
LUMBER GR.
FINAL INSP.
URINAL
SQ. FT.
�l ROOFING (//
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U:
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
CERT. OCC.
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 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.
�l ROOFING (//
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
'
GARDEN WALL FINAL