06060 (BLCK)}
P.O. BOX 1504 N o . 0 600
Building -52-890 Vallejo 78-105 CALLE ESTADO -
Address - LA QUINTA, CALIFORNIA 92253
Ownar
Xfarviu SurSeb
Mailing
Address 6 Fr:tekl y Fear Lme
CityFUmxtDaserlt zip 9226€1
Contractor
.. owner/builder
BUILDING: TYPE CONST. • - OCC: GRP.
"A.P. Number 773_324-007
�SN:w, Legal. Description
` Project Description 2 �tHi.+" inst An X 3009 lenRith.
City
Zip
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories - Units . r
Arch., Engr., -
•
Designer
New ❑ 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
• 7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and
• effec
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirin that I am exempt from the Contractor's License Law for the following
reason: •(Sec. 7031.5,8usiness and Professions Lode: Any city or county which requires a
Estimated Valuation
1500.00
'
PERMIT
'
AMOUNT
permit t6 construct, after. mmprove, . demofish, 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 contractors. License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Cade, 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).-
❑ 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 Contractors License Law does not appy to an owner of property who
Plan Chk. Dep.
-
•- . "
Plan Chk. Bal. ,
(--
Const.-
, r 64
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
Electrical
,
-
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.)
Plumbing
`
❑ 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 o1 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.)
❑ 1 am exempt under Sec B. S P.C: for this reason
1
Grading
Driveway Enc.
,
Date ~ ` ' ' �' Owner <-^ >f ,� 'l` s> : s r.-;�a,.r`
Infrastructure
WORKERS' COMPENSATION DECLARATION
1 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.
s
TOTAL'
CERTIFICATE OF EXEMPTION FROM ._
WORKERS' COMPENSATION INSURANCE ' ' »»
REMARKS
!!h:?tt.'t"`f;�o,a'7ii?IKT,.i+3s1�`-�14X'x3 Ai'f
(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 thF work for which this permit is issued, I shall not
employ anyperso- 4n in any manner so as to become subject.to the Workers' Compensation
Laws of California . r .'
Date owner I ! t! rf^
NOTICE TO APPLICANT: It, 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'
coNsraucnoN 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, Civic Code.)
Lenders Name
Side Street Setback from Center Line ,
^. '
Side Setback from Property Line
Lender's Address
FINAL DATE
'Issued by:
Validated by:
INSPECTOR
7-5-89
Date Permit
This is a building permit when property filled out, signed and validated, and is -subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 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
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEFS
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
STORAGE TANK
FORMS
ER OR I
MOBILEHOME SVC.
BAR SINK
POR SQ FT ®
ROCK STORAGE
FOUND. REINF.7- �- (
GAS (ROUGH)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
OTHER APP./EQUIP.
REIN F. STEED
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WALL SQ. FT.
DRINKING FOUNTAIN.
FINAL INSP.
URINAL
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING:
IKITCHEN 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.
SO. FT. ® c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
ME:CH.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
ER OR I
K
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.7- �- (
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REIN F. STEED
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
INSP.
ROOFING Lam— /� —
^FINAL
/ J (� ��
h�
^ 2
�1
�I �S�
I3 )
0
b
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL