002260 (SATT)P.O. BOX 1504 N �., 002260
Building 80-544 Pebble MaCh78-105 CALLS ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
swwi
Mailing
Address 75-005 0=try (P+ Ub
City Zip Tel.
t - 9nO 1 569—Me
Contractor
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description PIZ WEA PIM 10 0
WORKERS' COMPENSATION DECLARATION
.I hereby affirm that I have a certificate of donsent toself•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. , 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
.(This section need not be completed it the permit is for one hundred dollars ($100) valuation
,or less.) -• _ . _ ..
certify that in the performance of the work for which this permit is issued, I shall not
employ any parson 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 property for inspection purposes.
Signature of applicant a i 1-_'J/ !' Date -77
Mailing Address
City, State, Zip
HARD COP)
TOTAL t 3,303.90
ZONE:
BY:
Minimum Setback
City
>
Zip
Tela
Rear Setback from Rear Prop. Line
State Lic.
& Classif.�
City
Lic. #
Sq. Ft. 2272
Size GM q82
No. No. Dw.
Stories i Units �.
Arch., Engr.,
Designer
New ❑ Add O
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
Validation:
City
-
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that [,am licensed under provisions of Chapter 9 (commencing with Section
7000) 6f-Divisionr3 of%the Business and Professions Code, and my license is in fulGforce;and
effect.
SIGNATURE F A,i.111 - 4 DATE
f- V OWNER•BUIL'DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law forthe 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 permitdo, file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Sec_ tion 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
' subjects the applicant to -a civil penalty of not more than five hundred dollars ($500).
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
. 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.) ' -
O 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 I am exempt under Sec. B.-& P.C. for this reason
Estimated Valuation
�§ �f �1rt
S 1445[ . •tom/
-
PERMIT
'
- - AMOUNT
Plan Chk. Dep..
Plan Chk. BBI.
Lgeyi C�t3
3�Dl,. �ti3r
donSt.
4�p2� �ry
%5.50
Mech:
00
ElectrlCal
�,��, �,%
Plumbing
S.M.I.
9.84
Grading
-
Driveway Enc.
Date Owner
Infrastructure
20 00.€0
WORKERS' COMPENSATION DECLARATION
.I hereby affirm that I have a certificate of donsent toself•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. , 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
.(This section need not be completed it the permit is for one hundred dollars ($100) valuation
,or less.) -• _ . _ ..
certify that in the performance of the work for which this permit is issued, I shall not
employ any parson 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 property for inspection purposes.
Signature of applicant a i 1-_'J/ !' Date -77
Mailing Address
City, State, Zip
HARD COP)
TOTAL t 3,303.90
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 4-8Permit
Validated by:
Validation:
A 5 0 9 0
4 8 331.396 CK
CONSTRUCTION ESTIMATE Amilk
NO. ELECTRICAL EESdimk
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. I SQ. FT.
WALL SQ. FT. ®
SQ. 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
44eOUGH PLUMB./O—/�6—r`
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN 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.
SQ. FT. ® c
BATH TUB
WATER SYSTEM
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
INAL INSP. .2 /g
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
licco ROUND PLUMBING6
UNDERGROUND
A.C. UNIT
COLL. AREA
AA LAB GRADE 7, a,
44eOUGH PLUMB./O—/�6—r`
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
04lkEWER ORS PT 9,TA
(GLROUGH WIRING/O �6 O ig
�v
DUCT WORK
ROCK STORAGE
L'`�CFOUND. REINF. , /O G
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL `7 2 �e
'
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
INAL IN P.
BOND BEAM
WATER SYSTEM
GRADING
Cu.Y d.
plus x$
_$
LUMBER GR.
INAL INSP. a /
Z/`FRAMING G �/_ �,,, /_
Y/
INAL INSP. .2 /g
ELS— FING l0 — / —&. G
`VENTILATION i
y I11/ +�iL ��
r Q 2 I � /$'
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
GLJdNSULATIONISOUND 10 , jq —
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL