003172 (SIGN)M
r
P.O. BOX 1504 -,No . 003172
Building. 78-105 CALLE ESTADO
Address 7 i MAIMMY III LA QUINTA, CALIFORNIA 92253
.. Owner .. -... - -.. ... .. ,. _ _ ... _.
Mailing BUILDING: TYPE CONST, OCC: GRP.- '
� -
Address S TM La otinta pl=a
A.P. Number
City Zip Tel.
UA..; 9220
564-2,727 Legal Description
Contractor Project Description Two For Salt=y Sr "Ukase-
Address
e r/D .iuer , Sim at plaza La- Quiata-
Address .. .. ..
City Zip . Tela
State Lic.
City
& Classif..
Lic. #
Sq. Ft.No
Size . F2 r sf
No. Dw.
Stories Units
Arch.; Engr., •- ...
Designer.
New ❑ Add ❑
Alter O Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION _
I hereby affirm that I 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.
n'
SIGNATURE DATE
' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 theiefrom, 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 ($500). -
• ❑ 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 wt o does such work himself or through 'his own employees,
provided that' such improvements are not intended or offered for sale. If,. however,•'the- building
of lmprovement is sold within one year of completion, the owner -builder will have. the burden
. or proving that he did not build or improve for the purpose.of sale.) -
Estimated Valuation .
�09;A (VI
PERMIT
'
- • • '
AMOUNT
Plan Chk. Dep. .
Plan Chk• Bal.
COnSt.
Mech. '
Electrical
Plumbing
❑ 1, 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.) -
O I am exempt under Sec. • B: ti. P.C. for this reason
f
S.M.I.
- -
-
Grading
Driveway Enc.
_
Date 3^' Owner Gr 1% t-:� » --="
Infrastructure
WORKERS' COMPENSATION DECLARATION
kehereby affirm'that I have a-certificateof consent to' self -insure, or a certificate of
Worr's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE +.
(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 thg work for which this permit is issued, I shall not
employany person in any manner so as to become subject to the Workers' Compensation '
Laws of California.
a
015182, i� !:441.- QJIS-2141--9#'7 ,,,,, ,,., j.';
4,- q s � I r _ a -.. � ... �.
u
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: '
Front, Setback from Center Line
Rear Setback from Rear prop. Line
CONSTRUCTION LENDING AGENCY
Ihereby 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
FINAL DATE
Issued by: -
Validated by:
INSPECTOR
- Date 6/9?/R7 Permit
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 Jaws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant —Date—
ateMailing
MailingAddress
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES`
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
DEC 1 7 1987
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 APP./EQUIP.
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
—
DEC 1 7 1987
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