10039 (BLCK)Building 48-805 BL NIDO
e rt r1.n� o
Owner
CHOOL3IAW
Address $AME
P.O. BOX 1504 � No. 10039
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City
Zip
Tel.
LA QUINTA
92253
Contractor
QUALITY CONSTRUCTION
Address
75-465 MONTECITO
CityZip
Alter ❑ Repair ❑
Tel.:
INDIAN.WELLS
92210
340-6244
State Lic.
&Classif.B 555258
City
Lic.# 1938
Arch., Engr.,
Designer
Address
Tel.
CityI Zip I State
Lic. #
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 BusinessrOE Professions Code, and my license is in full force and
effect.,
SIGNATURE - 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: 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 of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe 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 thawfive hundred dollars.(E500).
O 1, as owner of the property, or my employees with wages as their sole compensation, will
t do the work, and the structure is not intended or offered for sate. (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. ti, however, the Wilding
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 Me 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 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate. of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certif`tediogpitkereot.-LSIy.V3800, Labor Code.)
Policy No. e'2111 ! ff I Company
.- "(A Copy is filed with.the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM.
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
I 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. ..I
Date-Owner�rT
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.
i
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 (wilding
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description BLOCK WALL — 61' X
6 •
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
$1,525
PERMIT
AMOUNT
Plan Chk. Dep.
+
Plan Chk. Bal.
' 1`
Const.
$45.00
Mech.
Electrical
Plumbing
S.M.I.
.20
Grading
Driveway Enc.
Infrastructure
TOTAL
.1:. .:a Z�. 4`rR,0ct._43—ti?, �+n 10
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF.DRAINS
CARP. SQ. FT. @
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEQUIP.
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.
SQ. FT. ® c
BATH TUB, -
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1V. c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
,LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE��FEE
PLCK.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.dZ
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM L I L
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- /Q (C.
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT FIREPLACES
43-780 Culebra Ln
Bermuda Dunes, CA. 92201
(619) 345-4003
To whom it may concern. 12-13-91
I am sending this letter in regards to the glass door that are needed
for your fireplace. These glass doors are on special order and we are
expecting delivery of these doors in about 6 to 8 weeks.
If you have any questions please give us a call.
q8- &5
L_0. Com• �z25�3
Thank you,
C.L. Householder
owner
Marco Fireplaces Superior Fireplaces Accessories