05594 (RPL)Building 80-611 GRAY RM
Address
Owner vzrt Ratthjeu
Address sem
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City Zip Tel.
La pinta 92253
Contractor
STM DODsOK CCN ., ON
Address I
68703 Perez Rai.
Cathedrbi Ctyl 022341 1 61?
State Lic. City
& Classif. A - 455607 1 Lic. #
Arch., Engr.,
Designer
Address
City (Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that am licensed under Provisions of Chapter 9 (commandwith Section
700(1) of Division 3 of the _Business and Professions Code, and my license Is in full force and
efieet
SIGNATURE _ _ - DATE
OWNE14 3URJMM DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 17031.5.L#skoss and Prdfissstors Cods: Any city Or county which requires a
permit to construct, sitar, brlprove, 1 0 1 or repair any sbucbae, prior to as issuance also
rOgWres the apnpdcatnt for such Permit to tie a signed sretemerd Vot he to 0censed pursuant to
the prorlstorta of the Conbadors Deese falx, Chapter rn
9 (conencing with, Section 7000) of
Dhlsion. 3 of the Business aOfe88
d Prof Code, or fhaf. he 1s exempt - therefrom, and the basis
for Me alleged exemption. Any violation of Section 7031.5 by any applicant for a pomp'
sutoocts-the'appdcert to a ch d penally of not more Vann Ove /xndod dollars (5500).
❑ 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, Buioness and
Professions Code: The Conpactor's Limme Law does not apply to an owner of Property whu.
buff or approves thereon and who files arch work hissed or through his own. empbyees,
provided that such inwrovernords are not Intended or offered for sale. 11 however, the building
or Irrproverrnent is sold wMh we year of con datim. the owner -budder wN have the burden
crPrortng.Mat he dict not'brrdd or byrove fordo pmpcee of sale.) _
❑ 1, as owner.of the property, am exclusively Contractingwith licensed contractors to con-
struct the project- (Sec. 7044, Business and Pmf roam Code: The contiaotoes License Taw
does not apply to ,an owner of pr[perfy who builds or agproves dwrow. sind who contracts for
such projects with a contraelydr(s) demnsedptaauef to the Conf radar s License Law.)
❑ 1 am exempt under Seo R & P.C. for this reason
Date Owner
WO KEW COMPENSATION DECLARATION
I hereby affirm that I=. a certificate of consent to self -Insure, or a certificate of
Workers Compehsatloa Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No (,--perry
❑ Copy Is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF E UMPTION FROM
WORKEW COMPENSATION INSURANCE
(This section need not be corn'Aleted B the pound 1s for one hundred dodea (S 100) valuation
orLess.)
1 certify that In the performance of the work for which -this permit is issued, I,shall not
=any ppeerson in any manner so as to become subject to the Workers' Compensation
Laws of Callfomia
:Date Owner
NOTICE TO APPLICANT: IT. after mating this Certificate of Exemption you should become
subject to the Workers' C.ampenswon prwtsfolis of the Labor Codeyou must forthwdh
comply wlfi such provisions or this pemett shadbe dawned revoked.
CONSTRUCTION LENDING AGENCY
1hereby affirm that there Is,a construction lending agency for the performance of the
work to► which this permit is Issued. (Sea 3087„ Chd Code.)
Lenders Name
Lenders Address
This Rs`a building permit what properly filled out,.signed and.validated, and is subject to
expiration if work thereunder Is suspeMed for 180 days
I cAC,
that I have read thLq epplicatico and stale that the above iMormatlon is correct.
I ogbuilding
consabovemenproperty for Inspectan purposes
Signature of applicant -Date-
Mailing Address
'City. State, Zip
No. 0-5594
11LDING: TYPE CONST. OCC: GRP.
P. Number
FGA ?TIS'
Description
t Description Pool & Spa
Sq. Ft. No.. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition 11
Estimated Valuation $21.000.00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
AMOUNT
•
rlectncal I I w•vv --
Plumbing 27.00
S.M.I. L.47
Driveway Enc.
Infrastructure
TOTAL E.
REMARKS
ZONE: BY: 1 r
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
4/4/84
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEESTROOF
PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
ING i2�A
YARD SPKLR SYSTEM
2ND FL SO. FT,
FORMS
SEWER OR SEPTIC TANK 7510;ROUGH
WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT ®
G S (ROUGH)
METER LOOP
GAR. SO. FT, ®
POWER OUTLET
'DRAINS
AS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP SO FT 0
GROUT 10WATER
HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=S
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
I
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ®c I
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 34c
HOUSE SEWER,
FI H GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEE:S
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
UND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB.
ING i2�A
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK 7510;ROUGH
WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
G S (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL I
AS (FINAL)
TEMP. POLE
GROUT 10WATER
HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xE
=S
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
s
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIOWSOUND
FI H GRADING
AINSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINRUILS
'
GARDEN WALL FINAL