002654 (AR)w� 1pQ�«rw
P.O. BOX 1504
78-105 CALLE ESTADO
Address 48-147 Calle sewt= � LA QUINTA, CALIFORNIA 92253
Owner
W. Near off
Mailing
Address
City
Zip
Tel.
La 'Oulz&A
9 253
❑ 1, as owner of the property, ormy employees with.wages as their sole compensation, will
Contractor
Address. .
41 6611 JamRi>ca- Vis$
'City"
Zip . .. t
Tel.
trtta,z3rt1 ttxt..q
921.
'•MeCh.
State Lic.
City
& Classif. 46565S►
Lic. #
- Arch., Engr.,
Designer
BUILDING: TYPE:CONST. OCC: GRP.•'
A.P. Number
Legal Description
Project Description
'693
,lie Sq. Ft. No. NO. DW.
Size , �.�- Stories Units
New ❑ Add QX - Alter ❑ Repair ❑. Demolition 0'
Address Tel.
City Zip State Fbw a&UtiAm
. - • . ... • 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.- .,'F-`"V%.EeS f�
SIGNATURE S I DATE'
OWNER -BUILDER DECLARATION' '
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' p V17i 0
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 thats:he is licensed pursuant to' PERMIT '
the provisions of the. Contractor's License Law, Chapler.9 (commencing with Section 7000) of -
AMOUNT
'• 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
-Plan Chk. Dep..
-
• subjects the applicant to a'civil penalty of not more than five'hundred dollars ($500).' - ` _
'
Plan Chk. Bal.
-
O. b�
❑ 1, as owner of the property, ormy employees with.wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bulsness and
COf1St.�
Professions Code: The Contractor's License Law does not .apply to owner of property who
builds or improves thereon and who does such work himself or through his own employees,
'•MeCh.
- 77It�� :1t'l
provided that such improvements, are not intended or offered for sale. If, however, .the building '
J..rislOO-
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 the purpose of sale.) • ..
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing+
• slrucl 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.
��
*50
• such projects with a contractor(s) licensed pursuant to the Contractor's License -Law.)-..
Grading
.. ❑ La_m exempt under Sec. B. 8 P.C..for this reason
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
'
I hereby affirm that I have a'certificale' of consent,to self -insure, lor 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. ❑ Certified copy is hereby furnished.
1
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
-
• or less.) • - - - - - -
1 certify that in the performance of th0 work for which this•permit is issued, I shall'not
r
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
ZONE:
BY:
subjectto the Workers' Compensation provisions of the Labor Code,- you must 'forthwith'
comply with such provisions or this permit shall be deemed revoked.
Minimum Distances: - -
-Front -Setback.from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
- Side Street Setback. from Center.Line
hereby affirm'that there is a construction lending agency for theperformance of the.
work for which this permit is issued..(Sec. 3097, Civilcode.)
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 it work thereunder is suspended for 180 days.
I
certify that I have read this application and state that the above information is correct.ISSUed
by:
Date J Permit
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.'
V8lidated by:
Signal ure.of applicant 1,/ i - r '-+ -- ".��f. Date
-
Mailing Address J« _r
Validation:
City, State, Zip
A655)
10 21 i 43,62 U
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ 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
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SEWER OR SEPTIC TANK
LAUNDRYTRAY
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
TEMP. POLE
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
ME.CH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
u
eND PLUM BI G
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEPLUMB.
Al ^�
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
H WIRING®2
6
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
M6ER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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.
r MING �n L /'
f�
FINAL INSP.
OOFING
�+ w^d/'
D
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�j
ING
MESH
ULATION/SOUND.
INISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
LAGUNA
llL LA. PAZ
October 21; 1986
18 X 24 PRINTED ON NO. 1000H CLEARPRINT •