003846 (CCOM)P.O. BOX 1504 NO... 003846
Building78-105 CALLE ESTADO
Address 78-140 Calle . Tamico LA QUINTA, CALIFORNIA 92253
Owner , . .. .
Ara. ""°''t'"`"" aa6iwas» '» '""""" ' cb4=,&C. BUILDING: TYPE CONST. OCG: GRP. .
Mailing
Addressq91 A h Q4 --,-g^ A.P. Number 769--030-035
City Zip - - - Tel.
Sant, .• r>t14 90402 .. 213.-45 -a 7.7 Legal Description
Contractor Caits .
- - Project Description
MIS
.Address..
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
Zip - Tel.
91405 818-785-4994
City
Lic. #
Tel.
City _ Zip (State
Lic. #
y J LICENSED CONTRACTOR'S DECLARATION _
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing'with Section
7000) of Divisiom2l of the Bru}siness and Professions Code and my license is in full force and
effect. - A, ,l.f i� .n^rrr x f>.4•ti. f'. 1-; :.. - eJf - f. _.-. .
SIGNATURE "" i 1 r [)ATE
r
OWNER -BUILDER DECLARATION
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, priorto its issuance also
requires the applicant for such permit to rile 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 Professions Code, or that. he is exempt therefioni; and the basis '
for the alleged exemption. Any violation of Section 7031.5 by eny-applicantfor a permit
subjects the applicant to a civil penalty or not more'thanrive hundred dollars ($500). -
❑ 1, 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 of.propegy 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.) -
❑ 1, 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 contractor(s) licensed pursuant to the Contractor's License Law.) -
•
0.1. am exempt under Sec.. B. & P.C. for this reason:
Date Owner
.R.. f
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 �-=t� '! iF > : l ''1�.__r _ ; . -
❑'.Copy is filed with the.city. ❑,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 the 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
Sq. Ft. No. No. Dw.
Size - Stories Units
New:lX Add ❑ Alter ❑'. Repair ❑ Demolition ❑
n . . ..$49F.500
PERMIT
Plan Chk. bep.
.Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
$3183.9#5
283 w 00
.47
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you - should become
ZONE:
BY:
- subject to the 'Workers' Compensation provisions of the Labor Code, you. must' forthwith
comply with such provisions or this permit shall be deemed revoked.
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
FINAL DATE
INSPECTOR `
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 this information
w �t cs
1`� /88 Permit
read application and slate that the above is correct.
'
Issued by:
Date41l
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST 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
CAR P. O.,FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL S0. FT.
OTHER APP.IEOUIP.
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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g 11/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 APP.IEOUIP.
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
INSULATIONISOUND'!
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE .FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL