001997 (SFD)Buildingre/- l55
i•--Addresss �j JJ3
Owner
Mailing
Address
City lZip
Contractor
Address
jZip
I
P.O. BOX 1504
78-105 CALLE ESTADO
. LA QUINTA, CALIFORNIA 92253
Y
No. 001997
BUILDING; TYPE CONST. OCC: GRP.
A.P. Number
Tel.
Legal Description e-, r
Project Description
State Lic.
City
Minimum Setback Distances:
& Classif..
Lic. #
Sq. Ft.
No. No. Dw.
Side Street Setback from .Center. Line
Size .
- Stories Units •
Arch., Engr., " '
INSPECTOR
Issued by:
Designer
New :W Add' ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
A384b
1 15 iLa00 Ck
]Rxisrti
; slab, check ftr POSSible
City
Zip
State
•
Lic. #
. LICENSED CONTRACTOR'S DECLARATION
.7.
dt
bUilM
'consttufti j•
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division/3 oof the Business and Professions Code, and my license is in full force and
"
effect , Y / -n c� wi
- .AR
SIGNATURE DATE
-
OWNER -BUILDER DECL,•ARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
_.
•
permit to construct, alter, 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
- 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
Section 7031.5 'any for
Plan Chk. Dep.
for the alleged exemption. Any violation of by applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (3500).
Plan Chk. Bal..
O 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
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.)
❑ 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
-
Driveway Enc.
Date owner
Infrastructure
t nn nn
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
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars I'S 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
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 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 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 properly for inspection purposes. A
Signature of applicant's - • ' �•� �- - t J �-� 'Date
Mailing Address �� r
City, State, Zip
HARD COPY
Qc�
TOTAL
REMARKS
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 1 x'5"86 Permit
Validated by:
Validation:
A384b
1 15 iLa00 Ck
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN
SO. FT. ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
--
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
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
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 GOND. 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 APPJEQUIP.
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 1987
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL