003754 (RPL)P.O. BOX 1504 No. 0 3.7 05 4
Building 78-105 CALLE ESTADO
Address 48-123 Calla SuPU-_,naS _ - LA QUINTA, CALIFORNIA 92253
Owner o M
Mailing '
Address
City
Zip ITeI-
.. .• "U''Q
New ❑ Add ❑ Alter ❑ Repair ❑. ' Demolition :O
Address
Contractor
City
f�assk�rx� Paea�.�
State
Address
...
Lic. #
4.3-375 Madison
1 iixeet
City .. -.
_.
Zip
« '-
Tel..
i dio
92201
_ -
Plan C. Dep. - - -
347-59 9
State Lic.
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
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City ..
8 Classif.QS$:i
P
Plumbing, w Qi
.Lic. #
BUILDING: -TYPE CONST. -OCC.- GRP.
A.P. Number 617W590m046
Legal Description
Project Description. Paul :S-A
Sq. Ft. No. No. Dw.
Size • - Stories Units
Arch., Engr:,
- Designer _
New ❑ Add ❑ Alter ❑ Repair ❑. ' Demolition :O
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'$ DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 31of the and Professions Code, 'and my licenseis in full force and
effect. eBBusiness
SIGNATURE `. "`"- - - DATE
OWNER -BUILDER DECLARATION`
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
$15, 0010. ,-
- reason: (Sec. 7031.5,Business and_ Professions Code: Any; cfty 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 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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
[II, as owner of the property, or my employees with wages as their sole compensation, will ..
•_ .
- PERMIT - - AMOUNT
.;r I - _
_ -
Plan C. Dep. - - -
Plan -
Chk. .
Bal.
a.
t AA @
Const. 12 •G R A .
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
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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
-Electrical - w
. 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.) . -
Plumbing, w Qi
❑ 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. • B. &.P.Q for this reason
....
S.M.I. -
Grading
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' A 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. 0,&e7' :v 'r �: .Company ["'-r . s'; ? i 0 J'15
• ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. �•
TOTAL
CERTIFICATE OF EXEMPTION FROM
- WORKERS' COMPENSATION INSURANCE t
REMARKS.
- • - _
(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 thg work for which this permit is issued, I shall not.�Y4s3ai3
- - employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
tt l.Zay x
_
Date owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you. should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. •
ZONE: BY: '
M Inlmum 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,Llne '
Lender's Name
FINAL DATE INSPECTOR
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.ISSUed
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 %�F - "� Date" -79'• 79
by: Date Permit
Validated by:
Mailing Address " r+ 1 r. N it-rrr
Validation:
City, State, Zip 1. >r..
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
UGH PLUMBC� C�
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT. p
e -GAS (ROUGH) ��
DRINKING FOUNTAIN
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
plus x$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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 ® 3/4c
HOUSE SEWER
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
UGH PLUMBC� C�
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
e -GAS (ROUGH) ��
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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
7 / l j
leg?, (6
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE/�j�}
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESINITIALS.
GARDEN WALL FINAL