07886 (BLCK)Building
,gr,Address 51-255 AVa
Owner
P.O. BOX 1504 0
No11 _88-
. 78
78-105 CALLE ESTADO
leslasca LA QUINTA, CALIFORNIA 92253
Mailing
AddresSI-255 Ave. Wasco
City Zip Tel.
La QuinU 92853 664-7050
Contractor
Address
City lZip Tel.:
State Lic�. City
& Classif. Lic. #
Arch.*, Engr.,
Designer
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
70 130) of Division 3 of the Business and Professions Code, and my license is in full force and
effect:
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
requires. the applicant for such permit to file.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 of the Business and Piofessions 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 (4y!l penalty of not more than five hundred dollars ($500).
0 1, as owner of the prop6r-ty,'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 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.) .
o 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'—'-
jV
Date Ow *dr 1
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I hive -a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insuranc6,.or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
0 Copy is filed with the city.. 0 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 thp 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. .1
Date Owner
NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become
subject to the Workirs'..'Compensation 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
Lender's 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 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
BUILDING: TYPE CONS OCC'. GRP.-
A.P. Number 773-O&S-013
Legal Description Lot I
Project Description 61 x 401 Barden Val I
Sq. Ft. No. No. Dw.
Size Stories Units
New 0 Add 0 Alter 0 Repair 0 Demolition 0
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
255 - 02
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.' 5/14/99ermit
Validated by:
Validation:
S'.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
NECH.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
FINAL INSP.
ROOFING
Q
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL