BLCK (04583)54420 Avenida Madero
04583
4-4
' P.O. BOX 1504 '
78-105 CALLE ESTADO
Address 54-420 madem„ LA QUINTA, CALIFORNIA 92253
Owner _
.' Cal West const2:""bC'' i6n -
Mailing 'BUILDING: `TYPE CONST. OCC. GRP.
Address X499 ve.lia Way A.P..Number 774-232i--007
City Zip Tel.
Palm Vesert 1 92260 .146-8864. Legal Description
Contractor Project Description 150” X 2" R€tmininl wall
$&-rat
Address
City Zip Tel.
State Lic. City
& Classif. Lic. #
Arch., Engr., y
Designer '
Address Tel.
City - Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I Aereby affirm that I am licensed under provision's 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` , ; `"F .+' w s,{,^`✓ r° .
SIGNATURE DATE
1 `
OWNER -BUILDER DECLARATION
Lhereby 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
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
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 of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
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
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,
provided that such improvements are not intended or offered for sale. If, however, the building
• s `
Sq. Ft. No. - No. Dw:'
Size Stories Units
New ❑' Add ❑ Alter ❑ Repair ❑ :. Demolition ❑
Estimated Valuation
PERMIT
.Plan Chk. Dep.
Plan Chk. Bal.
Const. F
Mech.
AMOUNT
or Improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) r
Electrical
!.
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. 8 P.C. for this reason
S•M•1•
-50
-Grading
Driveway Eric.,.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
_
' I hereby affirm that 1 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
.'
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
:.s 0051x: _, ,.g; T $•U.7;.,09 '"'1:L.t-55 _7 :c 'T?
y: r'.y +t
- -
(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.
e
Date Owner
" 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.
ZONE:' - BY: _ • _ _ • '
-
'Minimum Setback Distances:
es' - -
j '
Front Setback from Center Line• `
Rear Setback from Rear Prop. Line
CONSTRUCTIONLENDINGAGENCY -"'
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 Street Setback from Center Line
Side Setback from Property Line '
Lender's . Name t •.." '
Lender's Address s "`
- 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 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
sauhzerpesentatives of this city to enter the above-
• and hereby
ponstructionroperty for todpurposes.
tFINAL DATE M INSPECTOR
`9 /16/88
^ ISSUed by: - Date Permit
' y, .••mentioned
Validated b',r ; , ` •, - `} •, - -
Signature of applicant - t Date
Mailing Address
. Validation:
w
'City, State, Zip e - Y
GOLDENROD w ASSESSORS OFFICE HARD COPY FILE
..y Y . - .r ...-.,.:...: . .;. :r'+•_ .. . :,.r .•......:;:w - .•.h •.. t-.. °... ,.- r........ ..3;,:
r n , ; ,WHITE . FINANCE PINK APPLICANT GREEN BUILDING,
w.4.1. :t i',:t w1. `'.'}. :•A. .,d. .eY '. a-.:. r:.,nh.. ..iib; -.•(., ,.. .s✓. . »e s.,. sc: _..'r ,•v,,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEEn
ISI FL SO Fl pr $
UNITS
SLAB GRADE
2ND FL SO FT. @
'
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR SO FT a
DUCT WORK
ROCK STORAGE
GAR SO. FT. a
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP.IEOUIP.
DRAINAGE PIPING
CAR P. I SO FT. a
TEMP. POLE
WALL SO. FT. a
GROUT
DRINKING FOUNTAIN
SO. FT. U?
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
VENTILATION
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
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID (d 1'A c
SEWAGE DISPOSAL
SO.FT.GAR ig 3/4c
HOUSE SEWER
INSULATIONISOUND
GAS PIPING
PERMIT FEE
FINISH GRADING
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 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
WER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REINF. '%/� -�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
�f /f
L SOND BEAM 6 � � �(�
'l 1l/ (
WATER SYSTEM
GRADING
cu. yd.
E 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 SIGNATURESlINITIALS
GARDEN WALL FINAL
5Y Y,? O 'P.O. BOX 1504 APPLICATION ONLY
Building e• ® 78-105 CALLE ESTADO
Addres , LA QUINTA, CALIFORNIA 92253
Own . . ..., ; _ ,.. ,..>_ • ,
BUILDING: TYPE CONST. OCC. GRP.
Mailing "tet'
Address7%sy j, d
A.P.-Number
city R2.25-3
Tel. -
! j Legal Description
Contractor Project Description
Address
City ip Tel.. -
State tic./- Q City _-
8r Classif. ,.'9(/% r SCJ Lic. # Sq. Ft. No. No. Dw.
_
Size Stories - Units
Arch.,.Engr.,
Designer 1 New ❑ Add Alter ❑ Repair Demolition ❑
Address Tel. '
* l
/
City Zip State
'= Lic.# 1SO CJ ° R/
.
LICENSED CONTRACTOR'S DECLARATION -
1 hereby affj(m that
00) I am licensed under provisions of Chapter 9 (commencing with Section t '
70of S on of theBusinessaann d Professions Code, and my license is in full force andeff `
SIGNATII DATE '
-
OWNER-BUILDER DECLARATION Estimated VLilUatlOn
hereby affirm that 1 am exempt from the Contractor's License Law for the following • 1., Jl®
reason: (Sec. 7031.5,Busbess and Professions Cade: Any city or county which requires a / G✓
permit to constrict; after, improve, demolish, or repairanystructure, prior toits issuance also y .. , _
requires theapplicantfor such permit to file a signed statement that he is•licensed pursuanrto - PERMIT - - F AMOUNT
the provisions of the Conlractors 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 basisfor the alleged exemption. Any 'violation of Section 7031.5 by any'applicant for a permit- Plan Chk: Dep:---- - - - - - -
• subjects the applicant to a chdpenatly of not more than rive hundred dollars ($500). _
•- Plan Chk. Bal.
❑ I, as owner of the property; or-my employees with wages as.their.sole compensation,_will
do the work, and. the structure is not intended or offered for sale. (Sec. 7044, Bulsness and r
Const.Professions Code: The Contractor's License Law does -not 'appty•to an. owner of property who
builds or improves thereon and who does such -work himself. or,.through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building • Mech.'
or improvement is solwithin one year of -completion, the owner-budder. will have the burden Electrical
o`tprovig that he dd nat brTd or inprove forthepurpose ofsale.) --_ - ___ ,. _ _
.:1
.i 1, as owner of the property, am exclusively- contracting with licensed contractors to Corr Plumbing
struct,the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not appy to an owner of property, who builds or Improves-thereon, and who contracts for '•$•M•I, :e -' -' "" '"" A` ' 'L
such projects with a confrador(s) licensed pursuant to the Contractor's License Law.)
-❑ fain exemptunder Sec B. & P.C. for tins, reason - Grading _
7)19 Driveway Enc.
/%/ -`- Infrastructure
Date. -5- - r - 7
WORKERS' COMPENSATION DECLARATION .
• + -1 hereby- affiro that I have a certificate of consent to self=in5 u `or of
Workers Compensation Insurance, or a certified copy thereof: Sec!3800, Labor Code-) - ' • -
`Policy
No.' Company
" ❑ Copy is filed with the city: ❑ Certified co s hereby furnished;- -
TOTAL _
CERTIFICA OF EXEMPTION FROM REMARKS
WOR RS COMPENSATION INSURANCE
.'(nmis serXion •.need not`be' sled If the permit is for'one hundred dollars ($100) valuation - • tY'xi'S - b•r FS •li -2-RY n(- e71U
or Less./ y v
certify that i e performance of thg work for which this permit is issued, I shall not
employ any n in any manner so as to become subject to the Workers' Compensation
' Laws of Ca' omia ..
Dat Owner _
- NOTICE TO-APPLICANT. d, after-making, this Certificate of Exemption you should become ZONE: BY: - -
t to the Workers' compensation provisions of the Labor Code, you must forthwith
comply w1Msuch provisions orOft permit shall bedeemed revoked. - Minimum Setback Distances:
3 Front Setback from Center Line
Rear Setback from Rear Prop. Line
--
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) I Side Setback fromProperty Line
Lenders "Name
Lenders Address FINAL DATE INSPECTOR
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 _ -
I certify that 1 have read this applyati 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 btjectwn purposes., Validated by:
Signature of app ti - Date
Mailing Addis Validation:
%State, Zip
BUILDING DIVISION
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEEW
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT. ®
BONDING
YARD SPKLR SYSTEM
-_;
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS%
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. I SQ. FT. ®
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN
SQ. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
-
WATER PIPING
NOTE: Not to be used as property tax valuation
=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
IKITCHEN 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
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
INSULATIONISOUND
GAS PIPING
PERMIT FEE
FINISH GRADING
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.
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