001910 (BLCK)4 J.
ceaT Q"
P.O. BOX 1504 NO..001-910
Building 78-105 CALLE ESTADO a "�
Address 778-206 C%13e lklirte LA QUINTA, CALIFORNIA 92253
Owner ... ..- .. ... .. _ ..... .. ...: _ ..
Ste$''nh BUILDING: TYPE CONST. OCC: GRP
Mailing'
=
Address, A.P. Number
City Zip Tel.
92253 Legal Description
-Contractor Project Description
.Address.. M 2' to -eadstiM M&I as plax 011=5.
P.O. BICK 1000
City... Zip Tel.'
3a Qum 922.53 564-1335
State Lic. City
& Classif. Lic. # Sq. Ft. ' _ No. No. Dw.
Arch., Engr:, Size. • Stories -Units
Designer New p - Add ❑ Alter ❑' • • Repair ❑ Demolition ❑
Address Tel.
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 Division 3 of the Business and /Professions Code, and my license is in full force and
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SI N.4Tl1RE_
OWNER.BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following i3t1
.reason: ,(Sec. 7031.5,Business and Professions Code: Any city,of 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 PERMITAMOUNTAMOUNT
the provisions of the Contractor's License Law, Chapter'9 (commencing with Section '7000) of
'Division 3 of the' Business'and Professions. Code, or that. Re is exempt therefrom, and_the basis
for the alleged- exemption. Any violation of Section 7031:5' by 'any applicant for permit Plan Chk. Dep.. - -
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 - 'Const.., `
Professions Code: The Contractor's License Law does not apply to an owner.of propeny 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' yMech:. _
or improvement is sold within one year of completion, the owner-builder will have the burden "'EleGtrICBI
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 coni 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,.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
•❑ I am exempt under Sec_ B. & P.C. for this reason Grading
�/�g,•,f �3-�, �5,�,,,r Driveway Enc.
Date *A, Owner Sy s>� =/fjvC��s�r/l _ Infrastructure
WORKERS' COMPENSATION DECLARATION
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 -
orless.)
I certify that in the performance of thg work for which this permit is issued, I shall not-
employ
otemploy 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 Laboi Code, you•.must forthwith •. Minimum Setback Distances: '
comply with such provisions or this permit shall be deemed revoked. e-
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
Lenders 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. - • . •- . - .yw
I certify that I have read this application and state that the above information is correct. Issued.by: Date A 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:
Signature of applicant•_��7/�'! 4`w%r9if/ rad/( fa;Date - ��i
Mailing Address A-� ? �." " Validation:
City, State, Zips J`� rl. i. / C ! ✓
$.: �52:_11- A341.7.....11,. 2.6 20.00 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. S0. FT.
Port' - f SO FT ®
GAR. J S0. FT. ®
CAR P. S0. FT.
WALL S0. FT. ®
SO. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(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.
SO. FT. ®c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
� � y it
1987
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE dELECT.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 APP.IEOUIP.
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
c
AEC
� � y it
1987
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDFN WAj_ FINAL,--
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