002424 (BLCK)414-
P.O. BOX 1504 No. 002424
Building 52"'400 AvMida Valle - 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
C John i1 021st.
Mailing
Address P.O. SCU 2288
CityZip Tel.
iY 92202 564-2228
Contractor
ress.
BUILDING: TYPE CONST.
OCC: GRP.
A.P. Number -**'/ f/ r n 1..5
Legal Description /,5
Project Description
150. i1.
I. of 34 cot h.;b reft. vaU..
City
�3
Zip
Tela
State Lic.
City
& Classif.
Lic. #
Sq. Ft- 1W lin.
Size
fNo. No. Dw.
Stories Units
'
- Arch., Engr:,
Designer
New 0 Add ❑
Alter ❑ Repair ❑ Demolition ❑
M� 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) Division•3iiof
of the Business and Professions Code,* and my license is in full'force andt
effect.
t
/�...
.. -
SIGNATURE �.\i-t...F-.T �i...-Ks #�..�.. '7 .DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's, License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any, city or county which requires a
permit to construct, after, improve, demolish, or repair -any structure, prior to its issuance also
requires the applicant for such permit to file 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 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
subjects the applicant to a civil penalty of not more than five hundred'dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation
�y�
2jr2 T.
PERMIT
.. -AMOUNT
• Plan..Chk.'Dep.
Plan Chk. Bal.
-
CiOf1St .
-
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 improves thereon and who does such work' himself or. through 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 of sale.) .
Electrical'
'
Plumbing
- ❑ 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.)
❑ I am exempt under Sec. B. 8 P.C. for this reason
S.M.I.-'
Grading
-
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
Thereby 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. O Certified copy is hereby furnished.
TOTAL
CA A2
_
REMARKS
,
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(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: 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
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 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
Signature of applicant Date
Mailing Address ._ 7
FINAL DATE _
Issued by:
by:
Validation:
A5841 .
_ INSPECTOR
-Date • 6-14— permit
6 19 64,112 CK
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM `
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
''Ztk BOND BEAM��
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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 PLUMBINC
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./EQUIP.
/
GREINF. STEEL !.� O
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
''Ztk BOND BEAM��
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
9 FP7
DEC 17
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL