002912 (SFD)Building 55-137 Shoal CrWk
Address
Owner
Mailing
Address 75-05 00uptnr CW
City Izip
Contractor
Address.
Sam
City
State Lic. sale
& Classif. 2813130
Arch., Engr.,- - '
Designer
Zip Tel.
City
Lic. #
328
4 w.
P.O. BOX 1504 N o .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
X02912
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description PM M64m, IMM 13 A
PIM. 3 CR
t:�s�a 1i7C
Sq. Ftp 424 No. No. Dw.
Size Stories Units
New Q. Add ❑ Alter ❑. ' Repair ❑ Demolition ❑
sa
Address
Tel.
City
Zip
State
-
UCENSED CONTRACTOR'S DECLARATION
u
I hereby affirm that I am licensed under provisions of Chapter (commencing with Section
7000) of Division 3 of the -Business and Professions Code, and my license is in fullforce-and, ✓
effect. •' .. ` .. / ` f y.- c
_SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation. $ Ms727/ r.()o
.reason:
reason: (Sec. 7031.5,Business and Professions Code: Any city or county..which requires a-
to construct, alter, improve, demolish, or repair 'any structure, prior to 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 Codd,,' 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). ' - ' •
as owner of the property, or,my employees with wages -as their sole compensation, will
PERMIT - - AMOUNT*
•.
Plan Chk. Dep.. .. 3$0.
- .. '^
Plan Chk. Bal.. .44
Const. �f • 00
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
Mech. (�'�
•
builds or impioves thereon and who does such work.. himself or through his own employees,
• ,provided that such Improvements are .not intended or offerectJor 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.)
- Electrical'��
PlumbingP�-50
❑ 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.)
O 1 am exempt under Sec. B: & P.C. for- this reason
_.
S.M.I. 7M,
Grading
Driveway Eno.
Date owner
Infrastructure 1y.7M.91.
WORKERS' COMPENSATION DECLARATION
' I hereby affirm that I have's 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
❑ Copy is filed with the city. . ❑ Certified copy is hereby furnished.
TOTAL 2.751.21
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
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 lhg 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 of the "Labor Code, you must .forthwith•
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
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
Issued by: Date 2-4-87 Permit
Validated by:
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.
I agree to comply with all city and, county ordinance's andstate laws relating to building
construction, and hereby authoFize representatives:lof.this city to enter the above:
mentioned property for inspection purposes. i
j
Signature of applicant t i- _ ( ` J '." fi' . Date - �f �__
_
Mailing,Addreiss `^ r ✓ - r %
Validation:
A 7 2 8 4 2 10 2%51.21 B
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
Ask
NO. ELECTRICAL FE —
PLUMBING FEES
1ST FL. SQ. FT. @
UNITS
COLL. AREA
2ND FL. SQ. FT.
TOUGH PLUMBS/3_"
YARD SPKLR SYSTEM
I
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
SEWER OR SEPTI= F7
WOUGHWIRING /�
J
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
9/ v FOUND. REINF. 3 —���
GAS (ROUGH)4--12r, `g
DRAINAGE PIPING
CAR P. SQ. FT. @
HEATING (FINAL)
OTHER APP./EQUIP.
WALL SQ. FT.
GAS (FINAL)
DRINKING FOUNTAIN
SQ. FT. @
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
IN P.7 —.2
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL 'FLOOR SUSPENDED
JOA INAL INSP.,)_A F /
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
SPARK ARRESTOR
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
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 —/��C
ROUND PLUMBING �S,
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE �.+` ��y' ''
TOUGH PLUMBS/3_"
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI= F7
WOUGHWIRING /�
J
DUCT WORK
ROCK STORAGE
9/ v FOUND. REINF. 3 —���
GAS (ROUGH)4--12r, `g
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
�JFINAL
IN P.7 —.2
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
6hZINAL INSP. 9— —F
I
Z)WRAMING S
JOA INAL INSP.,)_A F /
2t/ZROOFING Q�nGIC L/ -�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
?04-ATHING
MESH
K INSULATION/SOUND -��
,I 1<
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS_
GARDEN WALL FINAL