002908 (SFD)P.O. BOX 1504 N o . 002908
Building 78-105 CALLE ESTADO
Address 55-305 Gboal Creek. LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75-005 Com* y Cub VP—
City Zip Tel.
...Mln, Desext f 92264 1 568-2828
Contractor
Address
State Lic.
& Classif. .2831"
Arch.; Engr.,
Designer'
IZip I . ITel.
I Lic. # 323
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Tim MW PMW. 15 A
Puri 3 CR
-
MQ
424 No. No. Dw.
Stories Units
New -M Add ❑ Alter ❑ Repair ❑ Demolition ❑
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
Y>
7000) of Division'3 of the Business and Professions Code; and'my license is in full force%and
"
effect. .�. - L a i r! "-✓r . ��: %/
SIGNATURE DATE
OWNER -BUILDER DECLARATION'Estimated
I hereby affirm that I am exempt from the Contractor's License Law for the following
Valuation .
q
�� ry� •.1i
A" 't7270.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or, county•which requires a
'
permit to construct, alter, improve, demolish, or repairany structure, prior to its issuance also
»•
requires the -applicant, for such permit to file a signed statement that he is licensed -pursuant to
'PERMIT
- - -r AMOUNT .
the provisions or the Contractor's License Law, Chapter 9- (commencing with Section 7000) of.
' Division Vol 'the Business and Professions Code, or thathe is "exempt therefrom, and the basis
for the Any' Section 7031.5 'any for
Plan Chk.- Dep.
- - -
alleged exemption. violation of by applicant a permit
subjects the applicant to a civil penalty of not'more than five hundred dollars ($5001.
Plan Chk.. Bal.
O I, as owner of the property, or my employees with wages as their sole compensation, will
U•
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.�?V
00
Professions Code: The Contractor's License Law does not apply to an owner of property who
•
builds' or improves thereon and who does such work himself or through his own employees,
Mech.
3� 4�
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
Electrical
�' 41
of proving that he did not build or improve for the purpose of sale.) ..
•
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
87.54
• -slruct•lhe 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.
l
such projects with a contractor(s) licensed pursuant to'the Contractor's License Law.)
Grading
•7�
0 I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
1,705.91
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
❑ Copy is filed with the city. ❑ Certified copy is hereby.furnished.
TOTAL
2.751.21
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for -one hundred dollars (s 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 '
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, youmustforthwith
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
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 it work thereunder is suspended for 180 days.
I that I have
2-4-87Permit
certify read this application and state that'the above information is correct.
Issued by:
Date
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. L' y
/Validated by:
Signature of applicant Date '
Mailing Address / % /
Validation:
City, State, Zip /r
A 7 2 8 8
2 10 21 U
HARD COPY
CONSTRUCTION ESTIMATE Adbk
NO. ELECTRICAL FE
NO. PLUMBING FEES
IST FL. SQ. FT. ®
UNITS
%✓ es LAB GRADE _elil �`
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
(ROUGH) 5'—P
i
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
AL INSP/_ n y
v a�
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
NAL INSP& 2 cl:il
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
1!
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SQ. FT. ®c
BATH TUB
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
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL 7
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
Q�SETBACK2-—S
GROUND PLUMBII 3UNDERGROUND
A.C. UNIT
COLL. AREA
%✓ es LAB GRADE _elil �`
OUGH PLUW,_- j.$l
BONDING
HEATING (ROUGH)
STORAGE TANK
66,�eFORMS r /Z�- ��
EWERO��11
OUGH WIRING``/ J7Q_S'
DUCTWORK
ROCK STORAGE
fc—/eOUND. REINF.2 1JeAWAS
(ROUGH) 5'—P
i
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
j�4eeEINF. STEEL-,!
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
AL INSP/_ n y
v a�
BOND BEAM
WATER SYSTEM
GRADING
— cu. yd.
$/ plus x$
_ $
LUMBER GR.
NAL INSP& 2 cl:il
�RAMING L/-��, C�/�
<NAL INSP.6.� 2 L( F?
v�G
1!
% G!
"� RO'd NGIC(
r
T6 `t-JOA/0
^ i e
({/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
X,eeLATHING - /—'71
MESH
INSULATION/SOUND;
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL