05138 (MFD5)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 78-197 Cr inson Drive LA QUINTA, CALIFORNIA 92253
Mailing
Address
City
Contractor
Address
Boulevard Dave looment
Zip
State Lic.
& Classif. 311261
Arch., Engr.,
Designer
BUILDING: TYPE CONST
No. 05138
_OCC: GRP.
O A.P. Number $;13 —7 *n_e I n
Tel. -
h.:Sr� .. A Legal Description
Project Description I1tt111r11ria+ 1%_ `a7."^ 9179 f.wtr 1A1
Tela
City
Lic. # 1177 Sq. Ft. 912. No. No. Dw.
Size Stories ' Units -
New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7001) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. •— •r
SIGNATLRE r v s •+ •! ° r. DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirin that I am exempt from the Contractor's License Law for the following
5 C� 2
reason: (Sec. 7031.5,Brrsiress and Professions Code: Any city or county which requires a
permit to construct, after, irprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such Permit to fie a signed statement that he is licensed pursuant to
PERMIT
AMOUNT
the provisions of the Canbactors License taw, Chapter 9 (commencing with Section 7000) of
Division 3 o1 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. De p
not
subjects the applicant to a ctvi penally of not more than five hundred dollars (5500).
Plan Chk. Bal.
Sv 275.61
❑ I, as owner of the property, or my with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, ttuisness and
Const.
',� 1 {�
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,
Mech.
'3 {��
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is said within acre yew of completion, the owner -builder will have the burden
Electrical
414.76
of proving that he did not bold or nprove for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
75.00
struct the project (Sec. 7044, gess 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.
4. SC)
• such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
-
❑ 1 am exempt under Sec R_ & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 1.467.57
Frin A-- red I Aare 3A 1S
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 82.272.71 1
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the pemrt is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
=any person in any manner so as to become subject to the Workers' Compensation
Laws of
California-
Date—Owner
alifornia.DateOwner
NOTICE TO APPLICANT If, after mafmg this Certificate of Exemption you should become
subject to the Workers' Cam rmnsafion provisions of the Labor Code, you must forthwith
comply with such Provisions Or this permit shall be deemed revoked.
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
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity 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 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
REMARKS
t1AC 4 it"3 # t1 17pp 4'..5—w) Gil}
10 i.?taf i. ti11t4t. I f(f, i 1
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
12/28/88
Issued by: Date Permit
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SQ. FT. ® $
UNITS
COLL. AREA
2ND FL SQ. FT. @
%
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
00,
SEWER OR SEPTIC TANK
ROUGH WIRING.
DRAINAGE PIPING
CAR P. I SO. FT. ®
FOUND. REINF.
GAS (ROUGH)
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
REIN F. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
TEMP. POLE
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
LUMBER GR. FINAL INSP. 6 Ild py r(
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ec
HOUSE SEWER
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
Ai --4z -a
SETBACK
GROUND PLUM ING �
NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE I icy
%
OUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
00,
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REIN F. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
l -f ---cu. yd.
$ -plus-x$-=$
LUMBER GR. FINAL INSP. 6 Ild py r(
FRAMING ( AL INSP. '1 tit T(
a(��;�q�,�1NQS
ROOFING
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWAL�ZZ 4/03
LATHING
MESH
INSULATION/SOUNf)S
FINISH GRADING
FINAL INSPECTION- 12
CERT. OCC.
ccurF duel
0
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J
V
Orl(3 tZ,`d
1
REMARKS:
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL