001621 (SIGN)Building
Address 79-403:
maning
Address Sam
City Zip
Contractor
Address
• (444Q"
P.O. BOX 1504 NO. 001621
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: -TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description
City Zip Tela
costa Mwe 92626 714-557-40U "
State Lic. City
& Classif. Lic. # Sq. Ft.
Arch., EngrSize
., � - -
Designer New1Q / Add ❑ Alter ❑ Repair ED Demolition ❑
r
Address Tel.
.2 I.D.. Sic= fdr Plaza la 4uinta
City Zip State
...� .. Lic. #
__LICENSED CONTRACTOR'S DECLARATION- _
I hereby affirm that I am licensed+under provisions of Chapter 9 (commencing with Section
7000j.of Divisions of the Business and Professions Code, and my license is in full force and
effec
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated VdlUatl
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Protessions Code: Any city or county which requires- a
permit to construct, alter, improve, demolish, or, repair any structure, prior to issuance also -
requires the applicant 'for such permit to file a signed statement that he is licensed pursuant to PERMIT
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 Plan Chk. Dep.
No. No. Dw.
Stories - • Units
AMOUNT
subjects t e applicant to a civil penalty o not more than live hundred dollars ($500).
- ❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
44.52do.the
work, and the structure is not intended or offered for sale. (Sec. 7044, euisness and
Const.
��}
68.50
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,
Mech.
.
provided that such improvements are not intended or offered for sale. If, however, the buildingT
or improvement is sold within one year of completion, the owner -builder will have the burden •
Electrical
y
of proving that he did not build or improve for the purpose of sale.)
❑ 1, 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 for
S.M.I.
'
such.projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
.53
❑ I am exempt under Sec. • B. & P.C: for this reason
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
182.055
CERTIFICATE OF EXEMPTION FROM
REMARKS
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
`
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date - Owner
NOTICE TO APPLICANT: If, ager 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
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
hereby affkm 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
FINAL DATE
INSPECTOR
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 this
7-12-95
read 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
construction, and hereby authorize representatives of this, city to enter the above-
mentioned property for inspection purposes* .�^
Validated by:
Signature of applicant �� ��% r •. .» AE- -.-.Date•_T
Mailing Address
Validation:
City, State, Zip
A1923
1. 12 i8205 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT, ®
CARP. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SO. FT. ®c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE TLUMB. 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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
— INAL INSPECTION ZS
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL