003838 (PAT)P.O. BOX 1504 N 0 .
Building 78-105 CALLE ESTADO .003838
Address 52"510 0brogon LA QUINTA, CALIFORNIA 92253
Owner
Jose Lopez BUILDING: TYPE CONST. OCC: GRP.
Mailing'
Address �� A.P. Number '7,.3x'985-066
City Zip Tel.
. 1. »*A X97 SA6A* -fd9 C)Legal Description
Contractor Project Description
Otnnidt/ Builder
Address.
City Zip Tela .
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Size, Stories Units
Arch.; Engr.,
Designer New O Add ❑ Alter ❑ Repair ❑ Demolition 0 -
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. .
SIGNATURE DATE
OWNER•BUILDER'DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation .$L700
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. PERMIT AMOUNT
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 i& exempt therefrom, and the basis'
-= for the alleged exemption. Any violation or Section 7031.5, by any applicant for a permit' Plan. Chk. Dep. -•
subjects the applicant to a civil penalty of not more lhan'five•hundred dollars ($500): -'
O I, as owner of the property, or my employees with wages as their sole, compensation, will Plan- Chk: Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness anda�
Professions Code, The Contractor's License Law does not, apply to an owner of property who - COf1St.G7 �t
�� -
builds or improves thereon and who does such work himself or through his own employees, Mech.'
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 EI2CtrICal'`
of proving that he did not, build or improve for the purpose of sale.) I .
O I, as owner of the property, am exclusively. contracting with licensed contractors to con- Plumbing
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. - .50
such projects with a contractor(s) licensed pursuant to the Contractor's -License Law.)
. ❑ I am exempt under Sec. 8. 8 P.C. for this reason Grading -
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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
O.Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
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.) p
I certify that in the performance of thg work for which this permit is issued; I shall not • �`y I r 1TOY 4L i
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 ZONE: BY.:
subjectto the Workers' Compensation provisions of theLaborCode, you must forthwith MinimUm.Setback Distances:
comply with such provisions or this permit shall be deemed revoked. -
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
Lender's Address
This is a building permit when properly filled out, signed'and validated, and is subject to FINAL.DATE INSPECTOR
expiration it work thereunder is suspended for 180 days. i5 / g
I certify that I,have read this application and state that the above information is correct. Issued by: 1"� Date`3• L 2/88 Permit
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. Validated by:
Signature of applicant Date
Mailing Address _. Validation: '
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. 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. 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
WASHER(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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR Q 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION /
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL