002947 (RPL)44
P.O. BOX 1504 Na. 002947
Building78-105 CALLE ESTADO
Address 55-306 11 = LA QUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: TYPECONST.- OCC: GRP.
Address 7.7"005 0=ftV CL)b ttriVID A.P. Number
City ZipTel.
Palm Dasdrt. 92253 .. 569-282.8 Legal Description
Contractor Project Description PM Wmt
Natal I cl . & d 0> 'V ala .14i PWS. Pe&l
Address..
mal above
City Zip Tel..
Sam sem sew
State Lia City
& Classif. 130 Lic. # 328 Sq. Ft. No. No. Dw.
Size Stories • Units
Arch.; Engr.,
Designer New ❑• Add ❑ Alter ❑ . Repair ❑ Deenolition'❑
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 in full force and '
effect. I �# L'/�. .ru ✓f .k .. A .
DATE - .. .. ..
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following n
reason: (Sec. 7031.5,Business and Professions Code: Any city or county .which requires a tl -
"permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance also AMOUNT
:requires the applicant for such permit to file a signed statement that he is .licensed pursuant to PERMIT •• -
z 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 Plan .Chk. Dep.
subjects the applicant to a civil penalty of more than five hundred dollars ($500)..-
O I, as owner of the property; or my employees with wages as their sole compensation, will Plan Chk. Bal.
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 Const.
builds. or improves 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 r�
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical .yy
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
slruct 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. '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
. ❑ I am exempt. under- Sec.B. 8 P.C: for this reason Grading
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I- hereby affirm that I have 'a certificate ofconsentto sell -insure,' or &* certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. O. Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hund: ed dollars ($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, 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. . '
CONSTRUCTION LENDING AGENCY
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.) .
Lender's Name
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.
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 /r r !f. S../�j.!1}7,t ;•:fir. Date''
Mailing Address
City, State, Zip
ino4nu L urT
TOTAL 2240
REMARKS .
ZONE:
BY:
Minimum Setback Distances:
Front Setback from.Center Line
Rear Setback from.Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line -
FINAL DATE
INSPECTOR
Issued by:
Date 2/24/87 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. SO. FT. @
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT, @
POWER OUTLET
ROOF DRAINS
CARP. SO. FT. @
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. 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
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SQ. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1+/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR @ 3/acHOUSE
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
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
- ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ -plus-x$-=$-
lusx$=$ROOFING
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL ..
IUN'b s1UnA1Uneb11NinAw_
GARDEN WALL FINAL