04259 (SFD)4 -4v
P.O. BOX 1504
'^
78-105 CALLE ESTADO
,Buildinn g. 7,-3 7 T*rr-a (20tta Cts LA QUINTA, CALIFORNIA 92253
Owner
Address r. ...
{ .�. _ `
Mailing;
BUILDING: TYPE CONST. OCC. GRP.
' ,
Address • 77 S,, Main St*o, SULte 1:06, q�3-7_90' 000
' sCity' r . Zip Tel.
$, �i�"it�t! gij�i•-;i"'$I Legal Description w •• „ . .
-Contractor ^� ��sMap•g1
Project Description
Address ' PAIM Rdya les Plan 3 B€ iUdirtty '
-City o -o- Zip Tel.
State-,Lic: City
& Classif.' ' 462814 Lic. # Sq. Ft: 70 No. :. No. Dw.-
Size Stories Units
Designer. -1 New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel,
City. Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby afflrm that.I ani 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
SIGNATURE- w•^" - •e DATE '
OWNER BUILDER t' DECLARATION
.* L,hereby afflrm'that I am.exempt from the Contractor's License Law for the following
Estimated Valuation
�ytl
Y WORKERS' COMPENSATION INSURANCE.
. reason:•�,(Sec. 7031.5,Business and Professions Code: Any city or county which requires a
(This.. section need not be completed if the permit is for one hundred dollars ($100) valuation
'
permit to 'construct, alter, improve, demolish, or repair any structure, prior to its Issuance also
or less.)
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
Date Owner
• Division 3 of, the Business and Professions Code, or that he is exempt therefrom, and the basis
•for rthe Any Section 7031.5 by for
Plan Chk. Dep.
-
- BY: •` '
,, alleged exemption.- violation of any applicant a permit
• subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
❑ I, as owner, of the property, or my employees with wages as their sole compensation, will
Rear Setback from Rear Prop. Line
` do the work, -and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
Side Street Setback from Center Line
��
Professions Code., The Contractor's License Law does not apply to an owner of property who
work for which this permit is issued. (Sec. 3097, Civil Code.)
•
builds, or, improves thereon'and who does such work himself or through his own employees,
Mech.
' wy
provided that such Improvements are not intended or offered for sale. If, however, the building
or improvement is, sold. within. one year of completion, the owner -builder will have the burden
of proving that he ilid not build or improve for the purpose of sale.)
Electrical'
INSPECTOR
J . 4$
. 13
0, 1, as'owner of, the property, am exclusively contracting with licensed contractors to con-
Plumbing
expiration It work thereunder is suspended for 180 days.
16.. a 00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
I certify that I have read this application and state that the above information is correct.
,
Permit
does not apply to, an owner of property who builds or improves thereon, and who contracts for
S,M•1••
99
such projects with a contiactor(s) licensed pursuant to the Contractor's License Law.)
Grading
mentioned property for inspection purposes..
•
Validated by:
❑ 1 am exempt under,Sec. B. & P.C. for this reason
r-
Signature of applicant Date
Mailing Address `
Driveway Enc.
City,':State, Zip
Date a 1 Owner
Infrastructure
a279•91A%
1.279,94;-
-"'
WHITE FINANCE PINK: APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE HARD COPY -'FILE
L:
_ 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
! O Copy is filed with the city. ❑ Certified copy is hereby furnished.
'
TOTAL.
CERTIFICATE OF EXEMPTION FROM
REMARKS
Y WORKERS' COMPENSATION INSURANCE.
(This.. section need not be completed if the permit is for one hundred dollars ($100) valuation
�} �fri !.
c tf t' ," e � ("'3 ^"i.'+4-(, 4+T 3' J
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 youshould 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 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
This is a building permit when properly filled out, signed and validated, and is subject to
{
7/7/89
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.
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-
mentioned property for inspection purposes..
•
Validated by:
r-
Signature of applicant Date
Mailing Address `
Validation:
City,':State, Zip
-"'
WHITE FINANCE PINK: APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE HARD COPY -'FILE
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
IST FL SO FT la $
UNITS
A.C. UNIT
COLL. AREA
B GRADE ?C/_7—
YARD SPKLR SYSTEM
2ND FL SO FT. a
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FTer
ND. REINF. 24 -A:?5
GAS (ROUGH)
METER LOOP
POWER OUTLET
ROOF DRAINS
GAR SO. FT.
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP. SO FT. fd
SERVICE
FINAL INSP.
BOND BEAM
DRINKING FOUNTAIN
WALL SO. FT. @
GRADING
cu. yd.
$ plus xS
=$
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. (a
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
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
FINISH GRADING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID a IA c
SEWAGE DISPOSAL
SO.FT.GAR (g Vic
HOUSE SEWER
FENCE FINAL
GAS PIPING
PERMIT FEE
INSPECTOR'S SIGNATU aESJINITIALS ,
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
SETBAC,K
LUMBING-L UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE ?C/_7—
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
ND. REINF. 24 -A:?5
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xS
=$
LUMBER GR.
FINAL INSP.
AMING 2 rZ
Lr
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
GA FIREWALL
G Z-,?
MESH
��"g
S IONISOUNDZ61
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATU aESJINITIALS ,
GARDEN WALL FINAL