003069 (RPL)t'4.
TA
P.O. BOX 1504 No.. 003069
Building 78-105 CALLE ESTADO
Address ei5_09.1 Shoal Creek LA QUINTA, CALIFORNIA 92253
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address
A.P. Number
PGA West
City
Zip
Tel.
L .Quintz
922y3
566..282$
Legal Description
Project Description
�a. $
l u �
ContractorPoo
G. is F001 const fiction
Address ..
68-•465 Perez Road
' City -
Cathedral Citl
Zip
92234
Tela
_ ..328-26844
State Lic.
City
& Classif. 275796
Lic. # 69
Sq. Ft.
No. No. Dw.
Size -
Stories Units
Arch., Engr., .. ..
Designer
Newt Add ❑
Alter ❑_ Repair ❑ Demolition ❑,
Address
Tel.
City
Zip
State
Lic. # -
LICENSED CONTRACTOR'S DECLARATION
'
1
I hereby affirm that Lam licensed under provisions of Chapter (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
_
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's. License Law for the following�V
reason: (Sec. 7031.5,Business and Professions Code: Any 'city or county which requires .a
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 !hat he.is licensed pursuant to
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/
'Division 30l the' Busiriesffi'and 'Professions Code,' -or that. he is exempt theielrom, and the basis-
/or the alleged exemption. Any violation o/ Section 7031.5 by 'any. applicant for a"permit
subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation,' will'
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
builds or improves thereon and who does such work himself or'fhrough his own employees,-
" 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
. of proving that he did not build or improve for the purpose o/ sale.)
❑ 1, 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 theContracfors License Law.)
.. O. I am exempt under Sec: B: & P.C. for this reason
EStlma ed Valuationq
V s -
$20,000"
- PERMIT-
..
•AMOUNT
-Plan C,hk. Dep.
'
Plan Chk. Bal.95.22
COf1st.
. pis
Mech.'16.00.
'Electrical
2-0. 00
Plumbing
14.00
._
S.M.I.
1 -
- 1.44
Grading
Driveway Enc.
.t
Dale owner
Infrastructures;
dig d1'~tx _ ,i3ta_t ti ,�
WORKERS' COMPENSATION DECLARATION
' 1" hereby affirm that I .have a certificate of consent to self -insure, ora 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��,3
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 thg 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. 1/, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labcr Code, you mustforthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
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 Date
Mailing Address
City, State, Zip
HARD COPY
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:.
Date4127/87Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. ®
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SO. 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,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.
SO. FT. RESID @ 11/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.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 IrELECTRICAL 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 APPJEQUIP.
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.
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
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL