002916 (BLCK)P.O. BOX 1504 No. 002916
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
U
" a Erighm BUILDING: TYPE CONST. - OCC. GRP.
Mailing
Address P.O.. PAMt 145$ A.P. Number 774-201--017
City Zip Tel.
• (Mint 92253. Legal Description %D't 5
Contractor Project Description
Address
Sam
City Zip . Tel.
State Lic. City
& Classif. Lic. # Sq. Ft. S No. No. Dw.
Arch.; Engr., -
Size Stories • Units
Designer New ❑$ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
• Lic. # -
LICENSED CONTRACTOR'S DECLARATION �� i
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._ .
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation y� A
I hereby affirm that I am exempt from the Contractor's License Law for the following $ 850.,/�0
reason: (Sec. 7031.5,Business 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 PERMIT AMOUNT
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 or Section 7031.5 by any applicant for a permit. Plan Chk. Dep.
subjects the, applicant to a civil penally of not more than five hundred dollars ($500). '
❑ I, as owner of the property, or my employees with wages as their.sole compensation,.wiII Plan Chk. Bal.
do the work, and tfie structure is not intended or offered for sale'' (Sec. 7044, Buisness and COf1St.�•�%
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 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.) -
O I, 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 Cf�
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I.' •JV'
such projects with a contractor(s) Ifcensed,pursuant to the Contractor's License Law.)
❑ 1 am exempt under.Sec: B. & P.C. for this reason Grading
/�i Driveway Enc.
Date Owne%f r a tf Infrastructure
WORKERS' COMPENSATION DECLARATION
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 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 anyPerson 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 . .
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.)
Lender's Name
Lender's Address
This 15 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 slate laws relating to building
construction, and hereby 'authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicantts� Date
Mailing Address
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 2-6-87 Permit
Validated by:
Validation:
A 7 2 7 4 Z b _ tCSG Cti
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUC-ION 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WA=L FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
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
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
ISH GRADING
i/iF AL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL