06650 (RC)4
P.O. BOX 1504 No. 0665
Building 78-105 CALLE ESTADO
Address M-441 Highway III LA QUINTA,;CALIFORNIA 92253
K#3 -Whiteside
Mailing
BUILDING:"TYPE CONST. OCC: GRP.
Address Same
A.P. Number
"
Legal Description
Project Description i@I181itSonFZP fir
_ ...,,RwWeea.Cardee flowal: shop. 3 aovl�ra
City
d.8:iit>La
Zip
92M ,.
Tel.
g1�$wi
Contractor
Polar Air Conditioning Inc.
Address
71-3844 Highway ill
CityZip
Baticho Xira
92274
Tel.', •.
Side Street Setback from Center Line
State Lic.
City ,
& Classif. 253565
Lic. #
Sq. Ft. No. No. Dw.
Size Stories Units
Arch.; Engr., -
New ❑ Add.0 Alter ❑ Repair ❑ Demolition ❑
. Designer
Address
Tel.
INSPECTOR
City
Zip
State
I agree to comply with all city and county ordinances and state laws relating to building
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 of applicant Date'
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usiness 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 Ne a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Divisfon 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 civil penalty of not more than five hundred daflars ($500).
❑ I, as owner of the property, or my employees em to with wages as their sole corn
p Y g 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
' blinds or improves thereon and who does such work himself or through his own employees,
provided that' such 'irnprovements are not intended or offered for sale. If, however, the building
or Improvement is sold within one year of completion, the owner -budder will have the burdenEI@CtrlCal
. .of proving that he did not build orvmprove for the purpose of sale.)
Estimated Valuation
PERMIT AMOUNT
-
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
. W
Q4.00
Plumbing
- ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to core
struct the project. (Sec. 7044, Business and Professions Code: The Contractors 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.)
❑ I am exempt under Sec B. 8 P.C. for this reason
-
S.M.I.-
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
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
tty�
REMARKS
; ,Y .�... W" • ..
(Alis section need not 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, 1 shall not
employ any person in any manner so as'to become subject to the Workers' Compensation
Laws of California
. Dat .
e Owner
NOTICE TO APPLICANT: ff, after 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
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.)
Side Setback from Property Line
Lenders Name
Lenders Address
' This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
expiration if work thereunder is suspended for 180 days.
certify that I have read this application and state that the above information is correct.
Issued by:
i I�lY��g
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 Date'
Mailing Address
Validation:
City,. State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. Ff. 0
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SQ F( ®
DUCT WORK
ROCK STORAGE
GAR. SQ_ Fr. ®
POWER OUTLET
IROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (FINAL)
WALL SQ. Ff. ®
DRINKING FOUNTAIN
GROUT
URINAL
SQ FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ -Plus-x$-=$
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. Fr. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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 D %
v
FINAL INSP.
ROOFING
P
/
Y
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�d Z
MESH
INSULATIONISOUND O
FINISH GRADING
FINAL INSPECTION Ua6e
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
'W AXJ
(#trT
of
Tib of 4a (ouinta
1111+1b*tto anb �Safet 34 -*' t tun
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the following: -
BUILDING ADDRESS 78-441 Hwy 111 ;
Use Classification Flower Shop Bldg. Permit No. 6650
Group B2 Type Construction Vn Fre Zone Use Zone CPS
Owner of Building DG & KD Whitside Address 78-441 Hwy 111
City La Quinta, CA 92253
By; Lonnie Day
Date: August 31, 1991
Building Official
POST IN A CONSTICUOUS PLACE