002344 (BLCK)P.O. BOX 1504
No. 002344
Building49 -3.75 Aveiida PeraaElu r^ 78-105 CALLS CALIFORNIAESTAD9
AddresLA QUINTA, ORNIA 92253
Owner � mittictm
BUILDING:'TYPECONST. OCC. GRP.
Mailing
Address
City Zip Tel.
Sit i t�a 9225.3
Contractor
CdIT�f''.'.:.'t�i
Address.
P.O. BMC 94&2
City' Zip ' Tel.97263
A.P. Number
Legal Description
Project Description
State Lic.
City
& Classif. 482U3
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
-Arch., Engr.,
Designer
New ® Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
i� .
f? fools �3 �Dl&* maU
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing'with Section
7000) of Dillon 3 of the Business and Professions Code, license is in full force and
N
and my
effect. „_ /. .J I;,:�.-��"". .
'w�� Y
_SIGNATl1RE'l-' DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for'the following
v
$375.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a'
-to
.i
permit 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 toPERMIT.
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) -of.
.�r~
' Division 3 of the Business and Professions Code• or that. he is exempt therefrom, and -the basis
for the Any Section 7031.5 'any fora
• Plan Chk: Dep.
.. -
alleged exemption. violation of by applicant permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). - -
-
Plan Chk. Bal.
❑ 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
.COf1St.
qO(
builds or improves thereon and who does such work himself or through his own employees,
Mech.
'
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
Electrical
of 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-
Plumbing
'
structthe project. (Sec. 7044, Business and Professions Code: The Contractor's License -Law
,
i does not apply to an owner of property who builds or -improves thereon, and who contracts for
S•M.I.
such projects with a contractor(s) licensed pursuant to the Contractorfs License Law.)
i
- -
Grading
❑ I.am exempt.under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
I WORKERS' COMPENSATION DECLARATION
' 1 hereby affirm that I have a certificate 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
CERTIFICATE OF EXEMPTION FROM
REMARKS
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 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. If, after making this Certificate 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 shall be deemed revoked.
,Minimum 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, Civil Code.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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. .
4-29-86
1 certify that I have read this application and state that the above information is correct.•ISSUed
by:
Date Permit
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 .� r
Validated by:
Signature of applicant V r `I Date
Mailing Address
Validation:
City, State, Zip ! _
A5450
4 29 20.00 7
' HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. - S0. FT. ®
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
1
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
!1-AOND BEAM
WATER SYSTEM
URINAL
SO. FT. ®
_$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
DC Q
a
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL . HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 % 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
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
V./FOUND. REINF.
C..
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
!1-AOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
—
DC Q
a
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL_ FINAL
ti: 14 L
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