002527 (BLCK)fell(/
f TAtyl 4
P.O. BOX 1504
No. 002527
78-105 CALLE ESTADO
Address � '"DIF LA QUINTA, CALIFORNIA 92253
Owner _
Mailing
BUILDING: TYPE CONST. • OCC: GRP. •
Address A.P. Number
City Zip Tel.
,. - omimrta 92253 Legal Description
Contractor Project Description
Gmy Stwk Cbnst.
Address..
7A- %ZA5 TAw t
City .. .Zip _ Tel..
i t � 92260 340=003
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
_
Size Stories Units
Arch., Engr.,.
Designer New ❑ Add OX Alter Repair ❑ Demolition ❑
Address Tel.
City Zip State Pettit to bistall T eimiliM arA 2 X 4 c aU.
Lic. #
LI_CENSED,CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section r
7000) of Division 3 of the Business and Professions Codeland my -license is -in full force and -
effect .. -f ..7 dv f� 3: e'111 !/ l
SIGNATUR R 4 - i^ +-f' ti i DATE
OWNER -BUILDER DECLARATION f i V
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation gy� 11 /�An
reason: .(Sec. 703 1.5, Business and Professions Code: Any -city or county which requires a..200.00 1.200.VV
permit to construct, atter, 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 .. - PERMIT 3 AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with - Sect -ion, 7000) of'A
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.
subjects the applicant to a civil penalty of not more than five hundred dollars (5500). -
❑ I; as owner of the property, or my employees with wages as their sole compensation, will Plan C0 k. Bal. 28.92
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.. I�l�
Professions Code: The Contractor's License Law, does. ,not apply to. an owner of property who - .
59
builds or improves thereon and who does suchworkhimself 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 of completion, the owner -builder will have the burden Electrical
of proving that he did not build, or improve for the purpose of sale.) - _ 14.00
❑ 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. — .50
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O. I am exempt under Sec. B. 8 P.C. for this reason Grading
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 87.92
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 the 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
.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
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.)
Lender's 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 purposed � jI♦ J
Signature of applicant X f t 1/ r ✓l! Ate+ Date f� j Jf ref .i
Mailing Address % J
City, State, Zip /
HARD COPY
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 R-6-965 Permit
Validated by:
Validation:
A6165
8 11 87,92 R
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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
JAMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
NC'
SO.FT.GAR ® 3/.c
HOUSE SEWER
REMARKS:
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 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
NC'
7 49$7
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL