002931 (BLCK)No.- 11
r w 44
P.O. BOX 1504 0029
Building 53'840 Ate'=eWn 78-105 CALLE ESTADO
Address LAQUINTA, CALIFORNIA 92253
Owner
"Mailing BUILDING: --TYPE CONST... • OCC: GRP.
Address R3
City Zip
. -14-nu92253
Contractor
Address .
' City lZip
A.P. Number
564-46-W, Legal Description
Project Description _
Tel:
State Lic.
City _
& Classif.
Lic. #
Sq. Ft: �, No. No. Dw.
Size 3V�*Stories Units '
Arch., Engr.; �. . .
• Designer
New ❑ - ... Add ❑ - Alter ❑, Repair ❑
Demolition 0 -
Address
Tel.
City
Zip
State
60f0ft Idgh
_
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
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec.-7031.5,Susiness and Professions Code: Any city or county, which requires a
permit to construct, atter, improve, demolish, or repair any structure,-prior.lo its. issuance also
requires. the applicant for such permit to file a signed. statement that he is licensed pursuant 4o
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 is exempt'therefrom, and the basis
for the alleged exemption. Any violation o1 Section 7031.5 .by 'any• applicant. for a permit
'subjects the applicant -lo a civil penalty of not more than live 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 (Seca 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property -who
Estimated Valuation
-
- -t:w
- - ` -PERMIT ••+s •• "' AMOUNT
Plan Chk..Dep.. - -
- • •-
.
Plan' Chk.' Bal.. 02
Const. +}t�T !f
.3P.:Jtl
McCh. ..
• ,
builds or improves thereon and who does such work himself or through his- own employees,
provided that such improvements are not intended or offered.;for,sale. If,. however, the building..
or improvement is sold withinone year of completion, the owner -builder. -will have the burden
orproving that he did not build or improve for the purpose of sale.) , , -
Electrical
.-Plumbing -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
• - slruct 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec.. B.•& P.C. for this reason
1 „
.. -
S.M.I. - - -
Mrk
Grading
Driveway Enc.
. .
.Date owner\i r �'=�-'� -r'"�•^ _ 17 � •'�""'�'�,:�.��._..
-
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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
64.02
_
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE _,..
REMARKS
- -
-
(This section need not be completed i1 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 o1 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. •
.,ZO N E: - ' BY:
Minimum Setback Distances: -
-
Front Setback from.Center Line
_
-•
Rear Setback from Rear Prop. Line
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. (Seo. 3097, Civil Code.) _
Side Street Setback from Center. Line
Side Setback from Property Line
"' ' " '
Lender's Name
FINAL,DATE -INSPECTOR-
'ISSued.by: Date 2-17-87 87 Permit
Validated by:
'Validation:
a7...3L5..._ .. 1...1.E 64,-(,..?..Ck
-
-
Lender's Address
This
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.certlfy 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 -of this city to enter the above-
mentioned property for inspection purposes. , �.. _ ,'
Signature of applicant
Mailing Address % '� 'r�` �' +
City, State, Zip
'
-
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
17 4991
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEEMECH.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 APPJEGUIP.
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
c DEC
17 4991
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 :d
J