002081 (SFD)P.O. BOX 1504 No. 002081 '
Building 78-105 CALLE ESTADO
Address XX 54-64€3 Alm VeIAWD LA QUINTA, CALIFORNIA 92253
Owner
Txm_r Ct BUILDING: TYPE CONST. OCC: GRP.
Mailing '
Address B A.P. Number 774-284-01-2/011
City Zip Tel. -•
la. Minta922s3. . 564-4i0$ Legal Description 13 . I4
Contractor Project Description
wilc ► and eS9= Fast.
Address .
IAN :'max
City Zip. -Tel.'
..`is 322L4 30-S4 .
State Lic. City624
& Classif. B1 267923 Lic. # appl Sq. Ft. �� 13�I� 0- No. Dw.
Size Stories Units.
Arch:, Engr.,
Designer New ❑ Add ❑X Alter ❑ Repair ❑ ' Demolition ❑
Address Tel.
CityZip State
. .. . 1. . 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.. 'i .'I/ l
SIGNATURE2` DATE
Y OWNER -BUILDER DECLARATION r..•.
I hereby affirm that I am exempt from the Contractor's License Law for'the.!following Estimated Valuation
reason: (Sec. 7031,5,Business and Professions Code: Any city or county which'`requires a
r • permit to construct, alter, improve, demolish, or repair any structure, prior to .ill' issuance also •', • -
- .requires the applicant for such permit to file a signed statement that he is..g6l6hsed.Pursuant -to-. PERMIT AMOUNT •-
the provisions of the Contractor's -License Law, Chapter 9 (commencing With Section .7000) of. t
Division 3'of the Busine'ss'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 fof%'permit Plan Chk.•Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500),,..x;+'"-•�
O I, as owner of the property, or my employees with wages as their sole compensation, will �. Plan Ctik. Bal..
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. toCOf1St.
_ an or property who 80.50
builds or improves thereon and who does such work himself.or through his own employees, 'MeCh:
provided that, such improvements are not intended or offered Jor sale. It, however, the building
or improvement Is sold within one year of completion, the owner -builder will have the burden Electricalw '
of,proving that he did not, build or improve for the purpose of sale.) -
00
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
strucl 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.- - .67
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
0Aam exempt under Sec.. B. & P.C. for -this reason ' Grading
Driveway Enc. 20.00
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
1 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
O .Copy is filed with the city. O Certified copy is hereby furnished.
-TOTAL 3.65.49
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars- ($100) valuation
or less.) • • — '
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 of Exemption you should become
subject to the Workers' Compensation provisions or 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 �! �� :2 ! r tit 7 G`�-. " Date
Mailing Address f 1 t' i""
City, State, Zip
HARD COPY
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 2-24-86 Permit
Validated by:
Validation:
A4387
r
2 Z4 1.6 5A 9 n
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. S0. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. FT.
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
ROUGH PLUMB.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROUGH WIRING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
DUCT WORK
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
WATER HEATER
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
GAS PIPING
PERMIT FEE
WATER SYSTEM
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
Y ~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.
RAMING
FINAL INSP.
ROOFING
®rr
7 100 G!
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
GAR. FIREWALL
LATHING
MESH
}INSULATION/SOUND -'J
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/NITIALS
GARDEN WALL FINAL