002366 (BLCK)Building
Address
Owner
Mailing
Address
City
4
P.O. BOX 1504 NO. 002366
���'� 78-105 CAL'LE ESTADO
LA QUINTA, CALIFORNIA 92253
Zip
La 92253.
Tel.
�A
Contractor
Address
City
.. MI. •
BUILDING: TYPE -CONST: OCC: GRP.
A.P. Number 774 -122 -OU
Legal Description Tat14
Project Description
State Lic.
City
& Classif.
Lic. #
Sq. Ft.No. No. Dw.
Size- •Stories Units
Arch., Engr.;
Designer
New❑g Add ❑ Alter ❑. Repair ❑ Demolition ❑
Address
Tel.
.
City
Zip
State
Lia #
LICENSED CONTRACTOR'S DECLARATION
hhereby 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
._. _. ..
-OWN ER -BU ILD ER DECLARATION
Estimated Valuation
I hereby affirm that I am exempl'from the Contractor's License Law for the followingf7</�si
reason: (Sec. 7031.5,Business and -Professions Code: Any, city or countywhich requires - a
permit to construct, alter, improve, demolish, or repair any structure, prior to 'its issuance. also
for: file that he is licensed
PERMIT AMOUNT
requires the applicant such permit -to a signed statement 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: tie. is exempt therelrom,' and'the basis
'any
-
Plan Chk. Dep.
for the alleged exemption. Any violation of Section 7031.5 by applicant for a.permft
.'subjects the applicant to a civil penalty of not more than five hundred dollars ($500):' ' " •-
Plan Chk. Bal..
❑ 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'
ConSt.. r•
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.) '
❑ 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
.
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
❑ 1 am exempt under Sec.- B: & P.C.-for this reason
i
Driveway Enc.
Date Owner
-Infrastructure
WORKERS' COMPENSATION DECLARATION w
' I hereby affirm'thatI 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.
^ ^
Gi s
TOTAL `tib
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, after making this Certificate of Exemption you should. become
ZONE: BY:
' 'subject to the Workers' Compensation provisions of the Labor Code, you must foithwith
Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. -
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
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 read this application and state that the above informationis 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 theabove-.'
mentioned property for inspection purposes.
Validated by -
Signature of applicant0..'1r�0%d Date
Mailing Address
City, State, Zip L fr
HARD COPY
Validation:
A5564 5 8 10.00 Ch
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD $PKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1114 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/4c
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 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
ROCKSTORAGE
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.
17 1,987
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