BLCK (2689)P.O. 60X1504 NO. 002689
Building '78-105 CALLE,ESTADO
Address 78-990. Hues Ave. S�kwe 10 LA'OUINTA, CALIFORNIA 92253
Owner.. .... ,... ,. .. , .. � . d .. .. .. - ... ., ...
Tamm W1 '
Mailing " BUILDING: TYPE:CONST: OCC: GRP::
Address se•'}EF7E? A.P. Number
City JZip Tel.
CiR33 .42253 Legal Description
Contractor.
_ Project Description
6�F7IYB3�t�o
Address
' City .... _ ....Zip. .. Tel.. _ ...�
Sam
State Lia City
& Classif: Lic. # Sq. Ft. No. No. Dw.
Arch:, Engr.,
Size, Stories. - Units
..-. ... .... .. ...... ..... .. •
' "Designer New .OX Add 0 Alter O. 'Repair O 'Demolition O.
y Address Tel.
City. Zip State 91 lin... feet .r .. �� � � 1
... ... Lic. #.. ' ...,
ca
LICENSED CONTRACTOR'S DECLARATION .
Ihereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 00) of Division 3 of the Business and Professions !Code,, and my license is in full force and u,
effect..
SIGNATURE DATE-
'
OWNER -BUILDER DECLARATION
Estimated VBIUBYIOn
Hereby affirm that I am exempt from the Contractor's License. law for •the following9'�..'
reason: (Sec. 7031.5,Business and .Professions Code: Any city or county:: which requires '
' permit to construct, alter, improve, demolish,, or repair any structure, prior to its issuance also - t rn: • - '
requires the applicant /or such permit to file a signed statement that. -he is licensed pursuant to •.PERMIT - AMOUNT -
.the provisions o! the Contractor's License Law, Chapter.9 (commencing with. Section 7000) o/
Division 3 o/ the Business and Professions Code, or that. he..is'-exempt theiefrom, and the basis
.. /or the alleged exemption. Any violation of Section .7031..5 by 'any applicant for a- permit-•.Plan.Chk. Dr p., _ -
subjects the applicant to a civil penalty o/'not more than -five hundred dollars (8500).
O I, as owner of the property; or my employees with wages as'lheirsole compensation, will:. Plan. Chk. Bal. .
do the work, and the structure is not intended or offered for sale: (Sec. 7044, Buisness and COnSt. 20'. 00
Professions Code: The Contractor's License Law, does -not apply to an owner o/.property who - '
builds or impioves,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 o/ completion; the owner -builder will have the burden - Electrical _ '
of proving that he did not build orJmprove for the.purpose of•sale.).
O 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 /or, $.,M.k - - - -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) • - - - -
Grading
O J am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
,Date Owner �f -r--'1f?w -� .,r._ _ �+ <+y .'r ._,� ell _ Infrastructure v
WORKERS' COMPENSATION DECLARATION
^ "I hereby affirm that I have a'certificate of 'consent to self -insure, or a certificate of s
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.) ••
Policy No. . Company
O Copy is filed with the city. O Certified copy is hereby furnished... -
TOTAL 20,00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE • .
(This section need not be completed if the permit is /or one hundred dollars (8 f 00) valuation
.. or less.)-.. ._ .. .. . _.. _
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 of Exemption .you should become ZONE:' •' - BY.:
subject to 'the' Workers' Compensation ,provisions- of 'the Labor Code, you must -:forthwith`-' -'
comply with such provisions or this permit shall be deemed revoked: • - • Minimum Setback Distances: -
Front Setback from Center..Line
4 Rear Setback from.Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback f.rOm Center Line
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 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.
,- I 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 r -
construction, and hereby authorize representatives ,of, this city to enter the above-: • '
mentioned property for inspection purposes. Validated by: „
_ Signature of applicant, r+ f- t` Date
Mailing Address ! Validation:
City, State, Zip
A6b8Z 11' _1 2O,GG Ck
_ ... -
HARD COPY '
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. p
POR. SQ, FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SO, FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
j
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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11A c
SEWAGE DISPOSAL
�1 �
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
DBL
TOTAL FEES
TOTAL FEESPICR�E
MECH.
MECH.FEE PL.CK.FEE
CONST. FEE ELECT.FEE
SMIFEE 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 APP.IEQUIP.
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
�1 �
DEC , 1987
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
tl,1 UM "J 01UNA 1 U ntWINI I IALJ
GARDEN WALL FINAL