003646 (PLBG)I
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IE
r P.O. BOX 1504 No. 003646
Building 78-105 CALLE ESTADO
Address 49-644 Avila. LA QUINTA,CALIFORNIA 92253
Owner
T. nor-.w' zak BUILDING: TYPE CONST. OCC.GRP.
Mailing '
Address .Sic' aGolfEstates
A.P.-Number - -
City Zip Tel.
La. Qu3,€1ta _ 92253 564-1188 . Legal Description
Contractor Project Description Sever .Connection
tcono S6;6r Seri ice
Address
P. 0,. Pox 192
City - Zip- - Tela _. ,
Palm .Desert 9226 1 3* -2793 ..
State Lic. City
&Classif.48#961 Lia'# 342 y . . Sq. Ft. No. No. Dw.
Size Stories Units
• Arch., Engr., '
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic.#
�+, ICENSED CONTRACTt7KS DECLARATION /
I hereby affirm I am licensed under provisions of Chapter 9(commencing with Section
7000)of Division 1ofdhe Business and Professions Code,and my license is in full force and
effect. rk't...... !. `tk^
_SIGNATURE t DATE
OWNER-BUILDER DECLARATION' Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following $500.00
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,, 'pdorrto 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 .s•
" 'Division 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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars($500).
q-1,as owner of the property,or my employees withwages-as their sole compensation,.will, Plan Chk..Bal.
do the work,and the structure isnot intended or offered for sale.(Sec. 7044,Buisness and COr1St. S20.00
.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 hirimself 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 Electrical
of proving that he did not build or improve for the purpose of sale.).
❑ 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. - - '
such projects with a contractor(s)licensed pursuant to the Contractor's License Law.) -
Grading
❑1a exempt under Sec. B.t:P.C.for this reason
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. 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 ;) �, ,,�s!.
orless.) .. _
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' Owner '
NOTICE TO APPLICANT. If, after making this Certificate of'Exemption you should become ZONE: - BY:
subject to'the Workers"'Compensation provisions of.the Labor Code, 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.(Seca 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 if work thereunder is suspended for 180 days. 2/17/88
(.certify'that I have read this application and state that the above-information is correct. Issued by: Date 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
1ST FL. SQ.FT.® $ UNITS
2ND FL. SO.FT.
YARD SPKLR SYSTEM
FOR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. I SQ.FT._
DRAINAGE PIPING
WALL SQ.FT.® DRINKING FOUNTAIN
SQ FT ® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH)
APPLIANCE DRYER 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. SQ.FT.®c BATH TUB
SQ.FT.p c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SQ.FT.RESID®11/4 c SEWAGE DISPOSAL
SQ.FT.GAR®3/ac HOUSE SEWER
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 r HEATING(ROUGH) STORAGE TANK
FORMSff40L�BEWER OR SE�P�I�TF>KI1Q� ROUGH WIRING DUCT WORK ROCK STORAGE
FOUND.REINF. GAS(ROUGH) a METER LOOP HEATING(FINAL) OTHER APPJEQUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP. cu.yd.
FRAMING FINAL INSP. $ plus x$ =$
ROOFING REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL