003775 (PLBG)4
P.O. BOY 1504 No. 003775
Building78-105 CALLE ESTADO
Address 53-311 Juarez LA_QUINTA, CALIFORNIA 92253
Owner
IfinLY- Ward BUILDING: TYPE CONST. OCC: GRP.
Mailing
AddressS8 @ - .. 774-034-015
A.P: Number
City Zip Tel.
. .. , Legal Description
Contractor Piloject Description 'Sdep8ge pit
Hamer Suver Crust. Inc. -
,Address
P. n.
City Zip Tela
cathedral CitV1 32234 _32V. -1854 -- -
State Lic. City
& Classif. 410375 Lic. # Sq. Ft. No. No. Dw.
Arch., Engr.
Size Stories Units
Designer' New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State -
_ Lic. #
City -7
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 BBusiness and Professions Code, and my license is in full force and
effect: ' •$% Ft F'
SIGNATURE I r - I[ DATE
" OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that l am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Coder Any city,or county which requires a '
permit to construct, alter, improve, demolish, or repair any structure,. prior to its issuance also - •:.N
requires the applicant for such permit to file a signed statement that he is licensed pursuant to- F PERMIT •.w -AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with.Section 7000) of
' Division 30
f the B-usiness 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. be
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). .
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
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. Const. $23. V V
builds or improves theieon 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 of sale.) -
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
Strutt 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.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
0 1 am -exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure
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 certified copy thereof. (Sec. 3800, Labor Code.) -
Policy No. Company '
O 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 (5100) valuation
or less.) -' �'3 X.f,)tt 1 fLTiNi ). r. Xy
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 .. Ownei
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 Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. -
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'ls a building'permit when properly filled'out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. h
I certify that I have read this application and stale that the above information is correct. Issued by: Date 4/5/88 8 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 in purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ® ,
POR. SO. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH).
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ec
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEEPLUMB. 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 APPJEQUIP.
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
v/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I NSU LATIONISOUN D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE -FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL