001686 (AR)v
P.O. BOX 1504 No. 00168
Building 78-105 CALLE ESTADO
Address 5�— `� 3; LA QUINTA, CALIFORNIA 92253
Owner
BUILDING - TYPE OCC: GRP.
Mailing• e/0 �= Ward FASItar
Address P_()_ Tk ARA � / A'. P. Number
City Zip Tel:
/ `l/f ,+ • /If 564-6 Legal Description
Contractor f Project Description �.
Address.. . - ". ... .. .. , . . .
City .. Zip�f�
State Lic. ! i�,�.t .City
& Classif. Lic. JP Sq. Ft. No. No. Dw.
.. i
Size - • Stories Units
Arch:, Engr.
7Designer , New ®: Add ❑ Alter ❑ Repair ❑ Demolition ❑
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
7000) of Division 3 of the Business and Professions Code, and my license is in full force and y
effect. .. . .
_SIGNATURE DATE
OWN ER -BU ILDER'DECLARATION Estimated. Valuation
I hereby affirm that I am exempt from the Contractor's 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 PERMIT - •- AMOUNT•
the provisions of the Contractor's License Law, Chapter9 (commencing with Section 7000) of
Division"3- of'fhe 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. Dep: -
subjects the applicant to'a civil penalty of not more than'tive hundred dollars ($500). '- ' Plan Chk. Bal.
❑ I,as.owner of the property,. or my employees with wages as their sole. compensation, will
Bothe work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
Professions Code; The Contracto ' License Law does not apply to an owner. of'property who
builds or improves thereon an ho does such work himself or through his own employees, Mech. • .
provided that such improveme s 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 Electrical -
of proving that -he did not build or improve for fhe.purpose of sale.)
'.O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing •
• slruct 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. S.M.I.
such projects with a contractors) licensed pursuanf to the Contractor's License Law.)
Grading
.,O 1 am exempt under Sec. .B. & P.C. for this reason . .
X.._1 Driveway Enc.
Date r�a,l �x d Ownar VI/041-`i'j'_;',�r Fj ',!+ r-Af>: Infrastrqu�th'i'ki ct�ure ps,
.�.al moi! iii \T _V
WORKERS'COMPENSATION DECLARATION
Ihereby affirm that I have 'a, cert if Cate 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. 0 Certified copy is hereby furnished.
• TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS.
WORKERS'. COMPENSATION INSURANCE.
(This section need not be completed 'if the permit is, for -one hundred dollars ($100) valuation - - -
-orless.)
I certify that in the performance of lhp 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. i
' 'Date ' Owner '
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:' -
Subject to the 'Workers' Compensation provisions of the Labor Code, you must' forthwith .Minimum Setlaa.Ck DlStanCeS:
comply with such provisions or this permit shall be deemed revoked. _ -
Front.Setback .ffrom 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
®�q �}g� S�
expiration if work thereunder is suspended for 180 days.. .. E7-i�Sie�.
I certify that I have read this. application and state that the above information is -correct. Issued by: Date 8— 95Permit
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 iinsype t o/n'purposes. g' Validated by:
Signature of applicant Imo'`7r.�s �� .J/. >r:. Date xr/A. 7i 1
Mailing Address /,"4- Validation:
City, State, Zip^
,C r r l f,_er A 2 3 5 4 8 2 0
HARD COPY F.
O 0 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH 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
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SD. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
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
FIRE ZONE ROOFING
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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE, DISPOSAL
SQ.FT.GAR Q 3/ac
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
IMECH.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 APP.IEQUIP.
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
.
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUFES /IN ITIALS,
GARDEN WALL FINAL