003093 (BLCK)Building
Owner
P.O. BOX 1504
78-105 CALLE ESTADO
52,760 Obregon LA QUINTA, CALIFORNIA 92253
mailing -
Address 43•-820 C$ e3 CIZele
City Zip Tel.
pain,utw-rt 92260 346--0237
Contractor
vee r/Ruilder
Address.
No. 0030093
BUILDING:' TYPE CONST. OCC: GRP
A.P. Number 773.315.002
Legal Description
Project Description g lRsxfas 4v& 41. T4.11
T
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' 'Owher
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.
1 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 properly for inspection purposes.
Signature of applicant Date
Mailing Address
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' 6/4 .87 Permit
Validated by:
Validation:
City
Zip
TeL "
State Lic.
City
& Classif.
Lic. #
Sq. Ft, b $�}
No. No. Dw.
•
Size
Stories Units -
Arch., Engr.;
Designer
New ®1 Add ❑
Alter ❑ Repair ❑ Demolition ❑
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
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: Any - city or county which requires a
-any
Y a s
permit to construct, alter, improve, demolish, or repair 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
'Divlslon'3 of the Business and Professions Code, or thaLhe'ie exempt therefrom, and the basis
for Any Section 7031.5 by 'any for
-..
Plan Chk:'Dep.
the alleged exemption. violation, of applicant a permit
' subjects the applicant to a civil penalty or not more than five hundred dollars ($500). '
Plan Chk. Bal.
S19.17
O, 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
CDnst
. 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;
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 burdenElectrlCal
'
°r - '` k • 4: 't 'aT ''^ 1
of proving that he did not, build or improve for the purpose of sale:)
! ,'� ,�tiu r, r -� ,
. ❑ 1, as owner of the property, am exclusively contractingwithlicensed 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.
qy;j
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Seca B:•& P.C. for this reason
Driveway Enc.
� ,r
� 4" AA/1 -' ee- �✓ �%r %
Infrastructure
.te Ower
_ n..
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have 'a certificate of consent to self•ihsure;'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.. .O. Certified copy is hereby furnished. .
TOTAL
".0 17
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' 'Owher
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.
1 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 properly for inspection purposes.
Signature of applicant Date
Mailing Address
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' 6/4 .87 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBCIYG-FEES' e
r
1ST FL. SO. FT. ® $
2ND FL. SO. FT. p
POR. SO. FT. ®
GAR. SO, FT. ®
CARP. SO. FT.
WALL SO. FT. ®'
SO 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
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
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 APPJEOUIP.
EINF. STEEL S
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 SIGNATURES11NITIALS
GARDEN WALL FINAL :d