08156 (RER)Irdess W021 Carte
Owner
Mailing
Address
SamCity; Zip Tel.
Zip Tel.'
State Lic. City
& Classif. i Lic. #
Arch., Engr.,
Designer
Address. Tel.
CityI Zip I State
#
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
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
effect.
aGNATr1RE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business. and Professions Code: Any city or county which requires a
permitto construct, alter. Improve,, demolish, or repair any structure, prior to its issuance also
repulses the applkant for such permit to Nle a signed statement that he ,is licensed pursuant to
the provls/ons o/'the Contractor's License Law, TWO`;
hapter 9. (commencing with Section 7000) or
Division 3 ofthe.Business and Professions Code, 0r Met�.he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by -any applicant for a permit
subjects theappllcant to a civil penalty of not more than Nve hundred dollars.($500).
p I, as, owner of the property,.or my employees with wages as their sole compensation, will
do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Bulaness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon and who does such work .himself or through his. own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement Is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
El I, as owner of the property,•am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's ,License Law
does not apply to an owner of property who builds or Improves thereon, and who contracts for
such pmjscts with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec: a. & P.C. for this reason.
rr
ate owner r��✓,'r`��
'0`a
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have. a certificate of consent to self -Insure, or a certificate of
Worker's.Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy Is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS', COMPENSATION INSURANCE -
(This section -need .not be completed if the permit Is for one hundred dollars ($ 100) valuation
or less.)
I certify that in. the performance of the work for which this permit is issued, I shall not
employ. any pe rson in any manner $o as to become sutgbct to the Workers' Compensation
California. /% ry
!'VOTI - Owner . {' j
TICS TO APPLICANT t, a r making this Certtk ate of Exemption you should become
.subject to the, 'Workers' C nation provisions of the Labor Code, you must forthwith
comply with such provisions this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of the
work for which this permit Is Issued. (Sec. 3097, CIO Code:)
Lender's Name
Lender's Address
This Is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 100 days. -
I certify that I have read this application and state that the above Information is correct.
1 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.
Signature of applicant Date
Mailing Address
City, State, Zip
)No. 08156
ii
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number 794-"1-001
Legal Description .��,,
Project Description add laytdndw to existing house
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk: Dep.
Plan Chk. Bal.
Const.
20.0
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
20.00
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 6/25/90 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT. 0
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SO., FT.
DRINKING -FOUNTAIN,
SO FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
GRADING
cu. yd.
$ plus x$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SO. FT. @.c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1'A c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® 3Ac
HOUSE SEWER
SPARK ARRESTOR
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
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 % 7/ 'f P
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING A164WIV
MESH
INSULATIOWSOUND 7/3/ Q�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL