BLCK (06828)Building
Address1-5
Owner
P.O. BOX 1504 No., V6'V28, -
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 -
BUILDING:. TYPE CONST'- OCC: GRP.
Mailing
Address P. 0. Box 386 773-14.4'- 313
,. - • -�'• A:P. Number � - -
City _Zip Tel.
Rambo.. ,g>s g .92270 egal Description
Contractor _.. 4' X 144' Carden wall '
er f Builder _ . Project Description
OwitAddress. r
City
State Lic. ,
& Classif. a '
' Arch., En gr.'
Designer
Zip • - . , I Tel.:
telly
Lic. # Sq. Ft. No.
Size -• - Stories t
No. Dw:
Units
New ❑ Add ❑ ' Alter ❑ . 'Repair ❑
Demolition 0 -
Address"
Tel.
'
City
Zip
State
Lic. #
r "'•:� LICENSED CONTRACTOR'S DECLARATION . ,
3
I hereby. affirm that I am licensed:under provisions of Chapter 9 (commencing with Section
7000)ffect of Division 3 of the Bus!'
tess and Professions Code,
and my license is in full force and'.
SIGNATURE _ DATE
„
OWNER-D`UILDEROECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation ,
S1,83Z -
reason: (Sec.. 7031.5,13nshess and Professions Code: Any city or. county which requires a
y`
Permit to construct, after, tnmrove, 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 Prot'essions 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 av8 penally, of not more than rive hundred doflars.($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bel.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const./� "
• Professions Code: The (dors L.ic rise Law does not ,apply to an owner of property who
•
_ bulds or improves thereon and who does such work himself or through his own employees,
Mech.
Provided, that• such knprovements are not Wended or offered for sale. If, however, the building
_
or improvement is said wr7h6r one year of completion, the owner-bugder will have the burden
-Electrical '
.of proving that.he did not build or unprove 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 buBds or improves thereon, and who contracts for-
A
S.M.I. ly
` such prgfects with a contractor(s) licensed pursuant to the Contractor's License Law.)
. ❑ I am exempt under Sem g. 8 p -C, for this reason
Grading
'
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- ❑ Certified copy is hereby furnished.
/ -
�.
TOTAL
- CERTIFICATEOF EXEMPTION FROM "
WORKERS' COMPENSATION INSURANCE
REMARKS w, .•� <'. :ori arA. n.s - t firs r s t^b
(This section need not be completed lf, tfre Permit is for one hundred dollars ($100) valuation •
k'�•r ; v
1� . • - , l ;.: u j,' ; i,7 :• '.l. E • '`:�„'� � .. • - p .
or less.) -.•x - ..
1 certify that in the performance of the work for which this permit is issued, I shall not
,
N, '
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
'
NOTICE TO APPLICANT. - 9, m after malting this o Certificate of Exemption you, should become,
•• •
ZONE: - • BY:
subject to the tt/orkers• Cmr n Provisions of the Labor Code, you must 'forthwith
• comely with such Provsions or this Peril shall be deemed revoked: -
- -
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
Side Street Setback from Center Line
work for which this permit is issued (Sec. 3097, Civil Code.)
Side Setback from Property .Line
Lender's Name
�.
Lenders 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 18D days.
1/121/90.
_ I 1 _certifythat I have read this application and state that the above information is cored. •-
to
Issued; by. " � Date �permit-
aree 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 1. for inspection purposes
Validated by:
Signature of applicant Date
Mailing Add mss
Validation:
..City, -State. Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROCK STORAGE
FOUND. REINF.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. SO. FT. ®
TEMP. POLE
WALL SO. FT.
DRINKING FOUNTAIN.
SD 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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® VAc
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
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.
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
y/!�/��j�a
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINRIALS
'
GARDEN WALL FINAL