05617 (SFD)Building 77-175 AVENIDA ARTEAGA
Address
Owner
mr/mrs. Gary xerney
Address I!!P-M
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City
Zip
Tel
L& (iuinta
92253
5
Contractor .
Address
No.
Stories
City
Zip
Tel."
State Lic.
City
& Classif.
Lic. #
Arch., Engr.,
Designer
Address
Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions 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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,131usiness and Professions Code: Any city or county which requires a
permit to construct, after, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 i i ii 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
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or knprove for the purpose of sale.)
O 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 contractors) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is file with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need riot be completed if the permit is for one hundred dollars ($100) valuation
or less.)
1 certify that in the performance of the work for which this permit is issued, I shall not
employ any PPerson in any manner so as to become subject to the Workers' Compensation
Laws of Caiifomia.
Date Owner
NOTICE TO APPLICANT: ff. atter 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.
CONSTRUCTION LENDING AGENCY
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.)
Lenders Name
Lenders Address
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
construction, and hereby authorize representatives -of this city to 'enter the above-.
mentioned property for inspection purposes.
Signature of applicant , Date
Mailing Address
City, state, Zip
No. 05617
BUILDING: TYPE CONST. -OCC: GRP.
Sec's �wqa ';1f+llYy
A.P. Number
Legal Description Lilt 27
Project Description Sim
BY:
,#
Minimum Setback Distances:}"� 1�y _yd 1 T77.9r.
't
A
Rear Setback from Rear Prop. Line
Sq. Ft- 4278
Size
No.
Stories
No. Dw.
Units
New ER Add ❑
Alter ❑ Repair ❑ Demolition ❑
INSPECTOR
4/7/89
Issued by:
Date Permit
Validated by:
Validation:
Estimated Valuation
$')06,745.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
847.70
Const.
Mech.
91.13
Electrical
Z32.26
Plumbing
16-5.59
S.M.I.
21.49
Grading
24.96 ,.
Driveway Enc.
Infrastructure
a • ��
TOTAL
REMARKS
ZONE:
BY:
,#
Minimum Setback Distances:}"� 1�y _yd 1 T77.9r.
't
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
4/7/89
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL: FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
y
SLAB GRADE f ?J [
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
FORMS
SEWER TANK
.01
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
(ROU
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT.
FINAL INSP.
WALL SQ. FT. ®
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
CU. yd.
$ plus x$
=$
URINAL
SQ FT ®
FINAL INSP.
FRAMING 7
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
4 /
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, 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 ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
FINAL INSPECTION
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 6 AIR COND. SOLAR
n r r4-4.
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
y
SLAB GRADE f ?J [
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER TANK
.01
ROUGH WIRING
DUCTWORK
ROCKSTORAGE
/
FOUND. REINF. S 3 /Q
(ROU
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REIN F. STEELAS
(FINAL) l� �3
TEMP. POLE
GROUT
WATER HEATER
ICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING 7
FINAL INSP.l� /2
7
ROOFING I/
4 /
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GA
MESH
INSULATIONISOUND 1 141m,
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Building
Address
Tjht 4 Qum&
P.O. BOX 1504 APPLICATION ONLY
/9S' A Lle vlv� 1l1'
4
Address
State`Lic.I City
& Classif.'_ Lic. #
Arch., Engr.,
Designer
Address Tel.
78-105 CALLE ESTADO
IUINTA. CALIFORNIA 92253
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
=01
Division 3 Of the Business and Professions Code, and my license is in full force and
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5.Business and Professions Code: Any cly or cooly which requires a
pemd to construct, atter. improve, demolish. or repair any shuchre. prior to is issuance also
requires the app8cant for such permit to tie a signed statement that he is Acensed pusuad to
the provisiars of the Contractor's License taw, Chapter 9 (commencing wih Section 7000) of
Da ion 3 of the Bustness and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemptionm. Any vi 1aticn of Secdon 7031.5 by 'ay appiwnt for a pemw
subjects the applicant to a cin? penalty of not more Mae fte hurH$ed dollars (5500).
O 1, 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, Busness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
bids or improves thereon and who does such work himself or through Its own employees,
provided that such improvements are not intended or offered for sale_ Q however. the biding
or irpmve mnent is sod within one year of completion, Me owner -odder will have Me burden
of proving that he did not build or aprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to cow
struct the project (Sec. 7044, Business and Professions Code. The Contractors Licence Law
does not apply to an owner of property who bolds or improves thereon, and who contracts for
such pis with a contractor(s) licensed pursuant to the Contractors License Law.)
O 1 am exempt under Sec. R_ & P.C_ for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to sellminsure, or a certificate of
Worker3 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the pend is for one hundred do/as ($100) valuation
orfess.)
I 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 'I
Date ,owner
NOTICE TO APPLICANT: lf, after mating this Certlicete of Exemption you should become
subject to the Workers' Compensation provisions of Me Labor Code, you most forthwith
comply uth such provisions or ti= permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Circ Code.)
Lenders Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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
construction, and hereby authorize representatives of this city to enter the above.
mentioned Property for inspection purposes.
Signature of applicant -Date-
Mailing
ateMailing Address_
City, State, Zip
BUILDING DIVISION
BUILDING: TYPE CONST. OCC. GRP
Number S/d A., :,4 120 Sod4- G o
hal Description �dTt�7%
ject Description S 'C" (� .
Sq. Ft. No.
Size Sto
No. Dw.
Units
New X Add ❑ Alter ❑ Repair ❑ Demolition ❑
Aimated Valuation 3OC
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
.Infrastructure
TOTAL
REMARKS
119—
AMOUNT
),o0
7 /. 2
13a 9.1,40
I?d,cam
a
14�r.3O
.2/.
c2O.00
� 9s
nIMTelf_S
.4.9 f
' "7� n n�xv
ZONE: BY:
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
Issued by: Date Permit
Validated by:
Validat
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO. ELECTRICAL FEES
NO. PI_U
G FEES
IST FL. SO. FT. @(a
ROUGH PLUMB.
UNITS
HEATING (ROUGH)
i
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
YARD SPKLR SYSTEM
GAS (ROUGH)
2ND FL. SQ. FT.
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
`
MOBILEHOME SVC.
WATER HEATER
BAR SINK
FINAL INSP.
POR SQ FT @A,•
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
GAR. SQ. FT.® da
POWER OUTLET
FRAMING
ROOF DRAINS
ROOFING
DRAINAGE PIPING
CAR P. SQ. FT.
VENTILATION
FIRE ZONE ROOFING
WALL- SQ. FT. @
_
FIREPLACE
`
DRINKING.FOUNTAIN
SPARK ARRESTOR
URINAL
SO. FT. ®
LATHING
ESTIMATED CONSTRUCTION VALUATION
INSULATION/SOUND
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
FINAL INSPECTION
MECHANICAL FEES
CERT. OCC.
WATER SOFTENER
FENCE FINAL
VENT SYSTEM FAN EVAP.COOL HOODSIGN
INSPECTOR'S SIGNATURESIINITIALS
WASHER(AUTO)(DISH)1,760
APPLIANCE DRYER
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
.2 -
COMPRESSOR HP
3.3
POLE, TEM/PERM
�6`
LAVATORY
S
HEATING SYSTEM FORCED GRAVIT
AMPERES SERV ENT
SHOWER
/ C�-
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 C
1417
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/aC
HOUSE SEWER
15-
SGAS
GASPIPING
I --
PERMIT
PERMIT FEE
�-
PERMIT FEE
PERMIT FEE
15
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE
CONST. FEE
ELECT. FEE
SMI FEE
PLUMB. FEE
36y.�
3,?..26
�/ y�
/6S s.
STRUCTURE PLUMBING EL�RICAIi 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.IEOUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL 71
6;L: