05135 (MFD5)Building
Address
Owner
j
Mailing
Address
City
Ors
Contractor
Address
4 4 am
P.O. BOX 1504
78-105 CALLE ESTADO
78-165 Crimson Drive LA QUINTA, CALIFORNIA 92253
Zip
State Lic.
& Classif. 311261
Arch., Engr.,
Designer
Address
City
6J
No. 05135
BUILDING: TYPE CONST. OCC: GRP.
,A InA A.P. Number 613-790-11109
- _� �� Legal Description
Project Description 11ji3ldivio 3A; 1l*" ?I'f: T^f- '17
City
Lic.# 1177. .
Tel.
State
Lic. #
Sq. Ft. 912 No. No. Dw.
Size' Stories - Units'
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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 Cade, and my license is in full force and
effect. --—;
SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5.6usiness and Professions Code: Any city or county which requires a
permit to construct, alter, Improve, dernoFsh, or repair any structure, prior to its issuance also
requires the applicant for such permit to fid a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 or the Business and Professions Cade, or that. he is exempt therefrom, and the basis
for the alleged exerni tion. Any vkAft" of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty or not more than rm hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intim or offered for sale. (Sec. 7044, Suisness and
Professions Code: The Contractors License taw does not apply to an owner of property who
builds or kmrproves thereon and who does such work Mmselr or through his own employees,
provided that such improvements are not Intended or offered for safe. ft, however, the building
or improvement is sold wrThn one year of corl*6om, the owner -budder wilt have the burden
of proving that he did not build orrmprove for the purpose of safe.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-.
struct the project. (Sec. 7044, Business ad P►o<essiors Code: The Contractor's License Law
does not apply to an owner or property who bui2s or improves thereon, and who contracts for
such projects with a contractors) licensed pursued to the Contractors License Law.)
❑ 1 am exempt under Sec– ---______& & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. ' Company
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEIIIPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be conpi ted B 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 person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: If, after mating this Ceddicae or Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this Permit shat 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.)
Lenders Name
Lenders Address
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 1 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
mated
PERMIT, `
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
�F�T1gtPt�'f't'f�Ei
TOTAL
REMARKS
AMOUNT
331.On
36.00
44.76
75.00
4.59
1,467.57
38.13
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 12/28/88 ermit
Validated by:
Validation:
1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
f
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
!
UNITS
JGROUND
SLAB GRADE I / b n�
' OUGH PLUMB..
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SQ. FT.
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
SQ FT ®
FRAMING 3
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
_
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
FINAL INSPECTION 3 O/Q
a
SQ.FT.GAR ® 3/ac
HOUSE SEWER
CERT. OCC.
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
r
SETBACK
PLUMBING
UNDERGROUND 7—/ q '1O
4f A.C. UNIT
COLL. AREA
JGROUND
SLAB GRADE I / b n�
' OUGH PLUMB..
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. l L G vO
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. 110 ,
FRAMING 3
FINAL INSP.
ROOFING
_
,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND'
FINISH GRADING
FINAL INSPECTION 3 O/Q
a
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
l
GARDEN WALL FINAL
1