05442 (RPL)4
P.O. BOX 1504 N o . 05442
j
Building 78-105 CALLE ESTADO
Address 51.-480 Juarez LA QUINTA, CALIFORNIA 92253
Owner
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AM Construction 11
Mailing BUILDING: TYPE CONST. OCC: GRP. t
Address P.O. Box 366 A.P. Number 773-043-013014 ►
City Zip Tel. i
. La i Uinta I . 92253 619/564-4832 Legal Description
Contractor Project Description' Pf3Z)2. SPA
AM Construction �
.Address . !
stATauto j
City Zip Tela
State Lic. City i
& Classif.� 7 84 Lic. # Sq. Ft. No.- No. Dw.
Arch., Engr., Size Stories Units I
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel. i
City. Zip State
Lic. #
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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
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SIGNATURE '"' DATE
OWNER -BUILDER DECLARATION Estimated Valuation �iA �.r�n +�
I hereby affirm that I am exempt from the Contractor's License Law for the following $7 �ItVV.QtF
reason: (Sec. 7031.5,Buyress and Professions Code: Any city or county which requires a 7
pemnit to Construct, ager, improve, demolish. or repair any structure, prior toits issuance also AMOUNT
requires the applicant for such perm& to file a signed statement that hes licensed pursuant to PERMIT
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than free hundred dollars ($500). +
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 7ti
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code. The Contractors License Law does not apply to an owner of property who Const. 117.E 1
builds or Improves thereon and who does such work himself or through his own employees, Mech. "
Provided that such ftMvonnents are not intended or offered for sale. d, however. the buddeng 24.00)
or improvement is said 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 of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to coo- Plumbing
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.I.n
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.).70
'
❑ 1 am exempt under Sec B. & P.C. for this reason Grading
Driveway Enc.
Date Owner Infrastructure
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WORKERS! COMPENSATION DECLARATION k
I hereby affirm that I have a certificate of consent -to seself-insure, or a certificate of
Worker's Compensation Insurance, ora certified copy --flier, L (sc. 3800, Labor Code.)
Policy No Company,( -,"' yry'' "�f'e � (S j
❑ Copy is filed with the city- ❑ Certified copyis,hereby furnished. 1
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE {}
(this section need not be
less.)completed it the permit is for one hundred dollars (5100) valuation
or
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 APPL.ICAW. 8, after mafamg this Certificate of Exemption you should become ZONE: BY: i
subject to the Workers' Conpensab'on provisions of the Labor Code, you must forthwith
comply with such provisions orthis permit shag bedeemed revoked. Minimum Setback Distances:
Front Setback from Center Line of
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
Lenders Address FINAL DATE INSPECTOR
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. Issued by: Date 3` 6/89 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. Validated by:
i
Signature of applicant Date
Mailing Address Validation: 1
City, state, zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. 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. SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
-$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
IKITCHEN 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.
SO. FT. ® c
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE __JCONST.
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 APPJEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL