002770 (RPL)4 (41�
P.O. BOX 1504 No, 002770
Building 78-105 CALLE ESTADO
Address 55"850 pinehwst LA QUINTA, CALIFORNIA 92253
Owner _
Mailing
Address 75 -WS cowtxy club Drive
City JZip Tel.
'on
.92260
Contractor
C. H. I
Address.
City
Tel:
State Lic. City
& Classif. 27579 Lic. # 69
Arch., Engr:;-. .
Designer
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description
Sq. Ft. No.
Size Stories
New p Add ❑ Alter O
No. Dw.
Units
Repair ❑. Demolition ❑ -
Address
Tel.
I >
City
Zip
State
Lia #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions,of-C hapter,9:(commencing with Section
7000) of Division 3 of,tlie Busi'ness•an"d'Professi6ns'Code, and my license is in full force and
effect. :ter. ✓
.. _ •.
.
SIGNATURE.' a DATE
' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
. reason: (Sec. 7031,5,Business and Professions Code: An 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.
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
EStlrTiated Valuation .
d+t��
' i9. • 00
'
-- PERMIT
AMOUNT
'. Plan Chk. De
Dep_
Division 3 of the Business'and Profession§ Code, of that.he is exempt'lherefrom,.and the'basis
for the alleged exemption. Any violation of Section 7031.5 by any applicant' for a permit
subjects the applicant to a civil penalty of not more -than five hundred dollars ($500).
❑ 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
_ 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,
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
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-
Plan C hk. BBI. -
�f,A
9.7, a
2
COnSt.
p1�
�.�4Y•�vsr
Mech.-
:W° 00
EIBCtrICdl -{�11
-
Plumbing
14600
• 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. 1. -
�
&.37
&.3 t
such projects with a contractor(s) licensed pursuant to the Contractor's License -Law.)
❑ .I.am exempt under Sec. _-B. & P.C. for this reason
Grading
Driveway Enc.
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, of 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. ❑ Certified copy is hereby furnished. '
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION. INSURANCE
(This section need not be completed i1 the permit is for one hundred dollars (S100) 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
subject to the Workers' Compensation provisions of the Labor Code, 'you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Infrastructure
TOTAL,
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from.Center Lin
e
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
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days. 4 a+.
I,certify that I have read this application and state that the above information is correct. Issued by: Date 12-19-86Permit
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 inspectionrpu posey Validated by:
Signature of applicant 1 f =. - Date Z-4% NA
Mailing Address f 1 Validation:
City; State, Zip
A7C97 1 12 18319 Cti
HARD COPY '
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
SLAB GRADE
2ND FL. S0. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ. 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
WASH ER(AUTO)(DISH)
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.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR @ 3Ac
HOUSE SEWER
LATHING
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL