07125 (PLBG)Building
Address 50--630 Calle
Owner
T a 0
4t!t 4.4 a"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address Sam
City Zip Tel.
La Euinta 92253 S64-4875
Aaaress
AMOUNT
P. Q. Box 665
'
City
Zip
Const.
Tela
India
92202
Electrical
34.'
State Lic.
City
& Classif. 2730$
Grading
Lic. #
Arch., Engr.,
Designer
Address
Tel.
City IZip I State
Lic.•#
LICENSED COINTRA~OR S DECLARATION
I hereby affirm that'll ani licensed undeYprovissions of Chapter 9 (commencing with Section
7000) of Division ofttie Business Profess' ns Code, andmy license is in.fulI f rce and
_SIGNATURE%..- pEit-B✓" DATE
7 ;;NUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usness and A'dessions Code: Any city or county which requires a
permit to conslnjct. alter, improve, deapish, of repair any stnncture, prior to its issuance also
requires the appLcant for such pemd to fie a signed statement that he is licensed pursuant to
the provisions of the Contrarxor'S (./cense 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 vkd3tian of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenally of not more than five hundred dollars (E500).
❑ I, as owner of the properly, 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
Professions Code: The Conbactues 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,
provided that such rrprovernents are not intended or offered for safe. If, however, the building
or improvement is sold wVA one year of completion, the owner -budder will have the burden
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-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec -------R & P.C- for this reason
Date Owner
WORKERS'COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No any
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed B the pemd 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: /, after malting this Certificate of Exemption you should become
subject to the workers' Canpe satin provisions of the Labor Code, you must forthwith
comply with such provisions or the permit shat 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, Clivi Code.)
Lenders Name
Lenders 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 cer fity that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinancesand state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City,. State, Zip
No. 07125
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 76"65-007
Legal Description
Project Description Run stew gm line to pool h"ter
Sq. Ft.
Size
New ❑
No.
Stories
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
IEstimated Valuation $300
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
I 155. 0
Mech.
Electrical
Plumbing
S.M.I.
*03
Grading
Driveway Enc.
Infrastructure
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 2/21/90 Permit
Validated" by:
Validation-.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
SLAB GRADE
2ND FL Sp. FT.
BONDING
YARD SPKLR SYSTEM
POR. Sp, FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. Sp, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I Sp. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL Sp. FT. ®'
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
Sp FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
FINAL INSP.
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES 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 Va c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
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 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
q�
C/�/ Aw
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
'
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t