06716 (BLCK)TAt!t
P.O. BOX 1504 N o . 0.6,716
Building78-105 CALLE ESTADO
Address 53-940 Velasco LA QUINTA, CALIFORNIA 92253
Owner ;
Wmzk Katmtan'
Mailing —6- BUILDING: TYPE CONST. • • OCC: GRP.
Address , 774-165-011
A.P. Number t 1
City - JZip Tel. �... •
�» Q>ziZ1$8 . 425- Legal Description
Contractor 3' X 50" RetaiBIng vall
Project Description
Jack. Cliwk,' Ji-
Address
P. 0. • Box 137.1
CityTel.:
Zip 1.
I& Qaieta 92353 A64_33tI
State Lic. City
& Classif. 506667 Lic. # , ------ Sq. Ft. No. No. Dw.
Arch., Engr., Size.. Stories 'Units
Designer New ❑ Add ❑ Alter ❑ Repair.❑ Demolition ❑. •
Address- Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby+affirm that I am licensed under provisions of Chapter 9 (commencing with Secfion
• 7000) of bivision 3 of the Busines's ah ProfessPions Code; and my license is in full force and i
effecL..T, )'f 1W:f f 3'� i7t F t •a rc t,%'_W� f
z
SIGNATURE - r DATE
OWNER -BUILDER DECLARATION Estimated Valuation
hereby affirfn that I am exempt from the Contractors License Law for. the following
reason_ (Sec. 7031.5,Rsihess and professions code: Any city or county which requires a
Permit to cons&uct, after. improve, demolish, or repair any structure, per to its issuance also - -
i requires the applicant for such permitto We a signed statement that he is licensed pursuant to PERMIT AMOUNT
Me provsiors o/ the Contractors License Law, Chapter 9 (commencing with Section 7000) or
Division 3 of fhe Business and Professions Code, or that. he is exempt therefrom, and the basis -
for the alleged exemption. Arty violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. -
subjects the appirant to a ciW penalty of not more than rive hundred dollars ($500). -
❑ I, as owner of the property, or my. employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Suisness and Const. e�V
Proressfans Code: The Conbactorls License taw does not apply to an owner of property who
buddds or improves thereon and who does such work himself or through his own employees, Mech.' '
provided that such irprovanents are not intended or offered for sale. It, however, the building
or improvements sold wdfdn one year of completion, the owner -builder will have the burden - Electrical
'
of proving that he M not build or improve for the purpose of sale.) - ,
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law _
does not apply to an owner of property who bunds or improves thereon, and who contracts for S.M.I. .07 -
• such projects with a contractor(s) icensed pursuant to the Contractor's License Law.) -
Grading
❑ 1 am exempt under Sem _-B. & P.C. for this reason -
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affiim that I have a certificate of consent to self -insure, or a certificate of
Works 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 REMARKS
WORKERS' COMPENSATION INSURANCE r
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation, - f ; lAt�i82 10, f 3?5 12 06--R «:, �1.4
or less.) Ate. w. .y .. Ma-••
cern that in the f' p Slt h•ti.x SY :L f i3 1 Y9+ R + �tr N
ty performance of nth work for which this permit is issued, I shall not 4 - •
employ any person'in any manner so as to become subject to the Workers' Compensation -
Laws of California
to Owrher
' N077CE TO APPUCANr: If, after making this Certificate of Exemption you should become
I
'
ZONE:
,
BY:
subject to the Workers' Cooperation provisions of the Labor Code, you must forthwith
cmplywahsuchProvisionorthsPermitshagbedeemedrevoked•
Minimum Setback Distances: ..
Front.Setback from Center Line
-
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
;k
work for which tnis permit is issued- (Sec. 3097, circ coda.)
Side Setback from Property Line
Lenders Name
-
. ,
Lenders Address
FINAL DATE
INSPECTOR
This is abuilding'permit when property filled out,'signed and validated, and is subject to '
expiration it work thereunder is suspended for 180 days.
1 12/6/89
I certify that I have read this application and state that the above information is correct.
'I
Issued by: *
Date Permit >
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.
Validated by:
_ . Signature of applicant Date
r
Mailing Address—
Validation:
City.. State, Zip c
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. a $
UNITS
COLL, AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SQ FT ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. @
GROUT
WATER HEATER
DRINKING FOUNTAIN.
WALL SQ. FT.
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SO FT ®
GRADING
cu. yd.
$ -Plus-X$-=$
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
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
INSULATIONISOUND
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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
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 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.
FRAMING
FINAL INSP.
ROOFING
�
Ate/
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