04934 (SFD)44
P.O. BOX 1504 N O . 04-934
Building 78-105 CALLE ESTADO
Address 49-035 Qtline2a Court- LA QUINTA, CALIFORNIA 92253
Owner
Bar (`n" ns'F'a nip a+. BUILDING: TYPE CONST.
Mailing OCC: GRP.
Address68-713 Perez Road A.P. Number part La Quanta
CityZip Tel.
Cathedral C1 3223 773-9024 Legal Description
Contractor Project Description Plan 1804 r Lot 29
Same
Address
City Zip Tela
State Lic. City
& Classif. 337077 Lic. # 1,219 Sq. Ft. 18`04 No. No. Dw.
Arch., Engr., - Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
effect.7000) of Division 3 of the Business and Professions Code, and my license is in full force and
_SIGNATURE '" DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that 1 am exempt from the Contractors License Law for the following 3 fa04
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
pemtit to constnrct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the appdcant for such permit to We a signed statement that he is licensed pursuant to PERMIT k - AMOUNT
the provisions of the Contractors 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 of section 7031.5 by any applicant for a permit Plan Chk. Dep. '
subjects the applicant to a raid penatty of not more than five hundred dollars ($500). -
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. S h is
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 Const. A n
brmTds or improves thereon and who does such work himself or through his own employees, 9
Provided that such improvements are not intended or offered for sale. IfMech. , however, the building 33 .00
•orarprovement is sold wiMn one year of completion, the owner -budder will have the burdenElectrical h J.
of proving that he did not !wild or improve for the purpose of sale.) 7 4
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing g'j��
struct the project (Sec. 7044, Gustiness and Professions Code: The Contractor's License Law
does, not apply to an owner of property who builds or 6mproves thereon, and who contracts for S. M.I. 6 .55
such projects with a contractors) licensed pursuant to the Contractor's License Law.)'
Grading
❑ I am exempt under Sec B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure 2,106.09
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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 $3..076.92 -.
CERTIFICATE OF EXEMPTION FROM REMARKS 4
WORKERS' COMPENSATION INSURANCE t
(Ibis section need not be completed if the permit is for one hundred dollars ($ 100) valuation
or less.)
1 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
N077CE TO APPLICANT: ff, after making this Certirrcate 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 shag be deemed revoked. Minim m 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, CPor7 Code.) Side Setback from Property Line
Lenders Name
Lenders Address r
This is abuilding permit when properly filled out, signed and validated, and is subject to FINAL D TE :::INSPECTOR
expiration if work thereunder is suspended for 180 days. 12/19/88
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
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
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SO. FT.
WALL SO. FT.
FT ®
ESTIMATED CONSTRUCTION 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
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
IKITCHEN 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.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1114 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® V4c
HOUSE SEWER
FINAL INSP. C
ROOFING S
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
D PLUMBINC22A�d
UNDERGROUND
A.C. UNIT
COLL. AREA
AD
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
F ND. REINF.
GAS (ROUGH) '
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
INF. STEEL
GAS (FINAL) 17
MP. POLE
i
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
=$
LUMBER GR.
,p
FINAL INSP. q r/
FRAMING
FINAL INSP. C
ROOFING S
�G�
v
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING I
MESH
INSULATIONISOUND Wet
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t