002652 (BLCK)Address.
Zip
92253
_ City.. Zip . .
1m 9226.
State Lic.
& Classif.. 397252
Arch., Engr., - -
Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 002652
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description
Tel.
568-4014
City
Lic. #jag
Tel.
Sq. Ft. No. No. Dw.
Size Stories Units
Naw Q. Arm 1-1 Altar F1 Renair F-1 Demolition ❑
Building
5r-£xx hale bkral sic i
Address
74-1
Owner
_
- . 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.... if Y^�ir;ri�.+-'{�! .- !•r# ?-,;ia
Mailing
Address Address
_ .
City
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
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also s
requires the applicant for such permit to file a signed statement that he is licensed. pursuant to
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 o/ 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
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
' 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 o/ 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
o/ 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 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 projects with a contractors) licensed pursuant to the Contractor's License Law.)
0 1 am.exempt under Sec. B. & P.C. for this reason
Estimated Valuation
' A
L 0
Contractor
AMOUNT
'
Address.
Zip
92253
_ City.. Zip . .
1m 9226.
State Lic.
& Classif.. 397252
Arch., Engr., - -
Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 002652
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description
Tel.
568-4014
City
Lic. #jag
Tel.
Sq. Ft. No. No. Dw.
Size Stories Units
Naw Q. Arm 1-1 Altar F1 Renair F-1 Demolition ❑
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE - J
(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 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 . -Owner -"
NOTICE TO APPLICANT. If, after making this Certificate o/ Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
REMARKS
t d
y
ZONE: BY:
Minimum Setback Distances:
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
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.
I certify that I have read this, application and state that the above information is correct. Issued by: Date 1.0 '20 88 Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby, authorize representatives offthis city to enter the above-
mentioned property for inspection p'u°rrp`oses.. .,Pj//` Validated by:
Signature of applicantAl j. ✓�r �1 Ll"S - Date�_%t>(.1 +_!?f
Mailing Address r Ar ' ✓ /I -"..T Validation:
City, State, Zip !_ -
' A 6 5 4 5 10 20 368G. CK
HARD COPY
T r
{_ fir _
5r-£xx hale bkral sic i
City
_ !1
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
- effect.... if Y^�ir;ri�.+-'{�! .- !•r# ?-,;ia
.. .. ...
_ .
.. SIGNATURE 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
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also s
requires the applicant for such permit to file a signed statement that he is licensed. pursuant to
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 o/ 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
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
' 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 o/ 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
o/ 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 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 projects with a contractors) licensed pursuant to the Contractor's License Law.)
0 1 am.exempt under Sec. B. & P.C. for this reason
Estimated Valuation
' A
1.2%5.70
. PERMIT
• a
AMOUNT
'
-
Plan Chk. Dep.
-
PlanChk: Bal.
I A _11)
COr1St.
Mech.
' Electrical
-
Plumbing
S.M.I.
Cn
Grading -
.�.....
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
❑ Copy is filed with the city.. ❑ Certified copy is hereby furnished.
-
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE - J
(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 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 . -Owner -"
NOTICE TO APPLICANT. If, after making this Certificate o/ Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
REMARKS
t d
y
ZONE: BY:
Minimum Setback Distances:
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
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.
I certify that I have read this, application and state that the above information is correct. Issued by: Date 1.0 '20 88 Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby, authorize representatives offthis city to enter the above-
mentioned property for inspection p'u°rrp`oses.. .,Pj//` Validated by:
Signature of applicantAl j. ✓�r �1 Ll"S - Date�_%t>(.1 +_!?f
Mailing Address r Ar ' ✓ /I -"..T Validation:
City, State, Zip !_ -
' A 6 5 4 5 10 20 368G. CK
HARD COPY
T r
. /
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. 0
HEATING (ROUGH)
K
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
PROCKSTORAE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. @
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN
SQ. FT. ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
c
i DE C
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® t+/a c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
INSULATIONISOUND
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 R AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
K
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
PROCKSTORAE
FOUND. REINF.
GAS(ROUGH)
METER LOOP
HEATING (FINAL)
UIP.
INF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
�AJ
%, ND BEAM CD z
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
c
i DE C
17
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
0 SUNAIR
POOLS
x w 1974
SUNAIR POOLS
Swimming 9)001
Designers & Duildlers
3 els 267 q
fle�t�. w a- LAL uil callo� s4vcco
k-
P.O.BOX 835
PALM DESERT, CA 92261
Phone (619) 568.4014
STATE LICENSE C-53.397252
q,
CITY
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CITY ®F LAtI tIli
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Ummun
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