002220 (SATT)CA -6 44. 1
ul�v Q944,
Building 80-539 Pebble�Z
Address
Owner
&Mrise O=pmy
Mailing
Address 75-005 Comtry Club Dav
City Zip Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
rcwu ams sc�*a� zcz �zs.szs
Contractor
Nati Mnr� and Land
Address--
No. 002220
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description PM €sem.° PM 10 0
PbaW- ' 6 B
.City
Sam
Zip
Tel.
Front Setback from Center Line
State Lic.
& Classif.
City
Lic: #
328
2272
Sq. Ft.
-Size MR 582
No. No. Dw. i
Stories Units
Arch., Engr.,-
Designer
New OX Add O
Alter O Repair O Demolition O
Address
Tel.
Issued by:
,Date 4-7-86 Permit
Validated by:
City
_ .
Zip
State
Lic. #
A508b
LICENSED CONTRACTOR'S DECLARATION
I hereby,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 ,/ ." y �...: t l -• d.,{.�.�. _. _ •.'t. e v DATE
`LOWNER-BUILDER DECLARATION
I hgieby affirm that I am exempt from tAe 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
the provisions or the Contractor's, License,/Law, Chapter 9 (commencing with. Section .7000) of.
Division 3 or the Business and Profession's 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
subjects the applicant to a civil'penalty of not more than five hundred dollars ($500). "e
as of the property, or,my employees with wages as their sole compensation, will
0 I, as
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,C
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
proving, that he did not build or improve for the purpose or sale.)
❑ 1, 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.)
O lam exempt under Sec. B. & P.C. for this reason
Estimated Valuation
'
.. PERMIT
- AMOUNT -
'
plan Chk. De p
Plan Chk. Bal..
4 62.89
Const.
Q�
544.50
Mech.
sAF!•
dot EE7liV!
Electrical
102.17or
_
Plumbing
Sm p
in.50
S.M.I.
- 9.AA
-
Grading
Driveway Enc.
Date owner
Infrastructure,Q%�Q
WORKERS' COMPENSATION DECLARATION
A hereby affirm that I have a'certificale 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.
TOTAL
3,303.90
CERTIFICATE OF EXEMPTION FROM
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
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 sof this city to enter. the above
mentioned property for'inspection purposes. - p
Signature of applicant �. ! �.} `s'.�i': 't •' 149Y i Date
Mailing Address
City, State, Zip
HARD COPY
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 4-7-86 Permit
Validated by:
Validation:
A508b
4 8 35„3,9() CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FE
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
0,%�jSIAB GRADE S
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. 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
WASHER(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
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a C
SEWAGE DISPOSAL
SO.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 COND. SOLAR
SETBACK
i& ROUND PLUMBIN!f "
UNDERGROUND
A.C. UNIT
COLL. AREA
0,%�jSIAB GRADE S
ROUGH PLUM
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPTICft
a�OUGH WIRING ���n
v Y
DUCT WORK
ROCK STORAGE
FOUND. REINF. G/ B'
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.
(,(LFRAMING
fly—FINAL INSP. O
ROOFING ��/ C /_
VENTILATION'
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
VLJ(AATHING
MESH
�ZINSUL.ATION/SOUND$ jr,
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL