002893 (SFD)ag .44
P.O. BOX 1504 No.
Building 5_9,054 Cteek 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75-005 M
City
Palm.Desert-
Contractor
.
Address
City
sam
Zip 92M T . el. 568-2828
—BUILDING: TYPE CONST.�
_�OCC; GRP.-
A.P. Number
Legal Description
M
Project Description VM PIPM 14 A
Plan 3 M
State Lic.
City
1627DM 1627
& Classif. 288130
Lic. # 3a
Sq. Ft. - GV No. No. Dw.
GV
size . . .424
. Stories - Units•
Arch., Engr., - - - -
Designer
New N_V Add 0
Alter 0, Repair 0 'Demolition 0
Address
Tel.
City
Zip
State
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 infull force.and, I
effect
SIGNATURE GATE_
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
$ MJ27.00
reason: (Sec. 7031.5.Susiness and Professions Code: Any city or county which requires a
Permit to construct, alter, improve, demolish, or repaii any structure, prior -to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
PERMIT'
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3'of"the, Business and -Professions Code, of that. he is exempt therefrorh, and the basis
to sto
the Any Section 7031.5 by 'any for
Plan Chk. Dep.
r alleged, exemption. violation of applicant a permit
subjects the applicant to a civil penalty of not more than five hundred. dollars ($500).
Plan Chk. bal..
3H0.40'
0 1, as owner of the property, or my employees with wages as their sole compensation, will
do he work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
460AV
Professions -Code: The .Contractor's License: Law does not apply to an owner of property who
buildslor-imp-ro'ves, thereon and who does such work himself or through his own employees,
Mech.
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 wig have •the burden
Electrical
67.41
of proving that he did not build or. improve for the purpose of safe.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
87.50
struct the -project. (Sec, 7044, Business and Professions Code: The. Contractor's License Law
does to builds improves thereon, for
S.M.I.
7.95
not apply. an owner of property who of and who contracts
such projects with a contractor(s) licensed pursuant to,the, Contractor's License Law:)
Grading
0 1 am exempt under Sec. & P.C. for this reason
Driveway Eric.
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. Comp any
0 Copy is filed with the city. 0 Certified copy is hereby,furnished.
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.)
I certify that in the performance of thQ 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_L_Owner
NOTICE TO APPLICANT: If, after 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.frorn 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
Le nder's Address
FINAL DATE
INSPECTOR'
.
. This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
.
__!-p
2-4-87
cer tity that I have read this application and state that the above information is correct
Issued by:
Date 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-.
mention . ed . property . I for inspection purposes..
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
A 7 2 5 8
2 6 i%5121 Ck
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEF
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS low
�%2(-/SETBACK
?bC-SLAB GRADE '3 �Q ��-�
2ND FL. SQ. FT. p
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH) �'7
DRAINAGE PIPING
WALL SQ. FT.,®
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
6aINAL INSP. / ?
r�
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
,
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 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
JL -113-4;n
ROUND PLUMBIN 00-S
UNDERGROUND
A.C. UNIT
COLL. AREA
�%2(-/SETBACK
?bC-SLAB GRADE '3 �Q ��-�
��;OUGH PLUMB4/.1 �'
BONDING
HEATING (ROUGH)
STORAGE TANK
ZL�FORMS 3-/ _�j
SEWER OR SEPTi� Y?
OUGH WIRING"/— g-,
/
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) �'7
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
6aINAL INSP. / ?
r�
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.9.�1NALINSP.(,-/5—!F
,
/eFRAMING Ll + iL _p
INAL INSP. / ��� S
r� v
?&1tROOFING�?
j
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
e`ZNSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL