002094 (BLCK)P.O. BOX 1504 No• 002094
Building78-105 CALLE ESTADO
Address AU 54-320 AVMX ValLA QUINTA, CALIFORNIA 92253
Owner
' John= '-&• BUILDING: TYPE CONST. OCC: GRP.
Mailing 4
r ^s F
Address P.0_ TAnx 22ARI A.P. Number
i.
City Zip Tel. ) r }}
.. 92202. 564-2228., Legal Description 1• ' # , 4. / . •k 1 I
Contractor Project Description '
Address r$-�v.. ^�, e
52-608 AMA& W � _ 155. lin, .�. M_9 Vi X20*. ZetP
City Zip Tela
La Q'mIA2 52253 .554-3447
State Lic. City
& Classif.. Lic. # Sq. Ft. No. No. Dw.
...Arch., Engr., _. .-..
Size Stories Units,
Designer New O 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= a '
7000) f Division 3 of the Busines♦s and Professiio��n`s Code, and my license is in full force and
ot
effect.. y - . l � tr )- `_ .
SIGNATURE DATE
( OWNER -BUILDER DECLARATION "
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation s� r�q/�
reason: (Sec, 7031.5,Business and Professions Code: Any city, or county which requires a. 24325.00
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 that he is licensed pursuant to - w PERMIT __ AMOUNT -
the provisions of the. Contractor's License Law, Chapter 9 (commencing with - Section 7000) of s. -
Division '3 o/ the Business arid -Professions Code, or that. he is exempt therefrom,'andthe basis-
for the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant • for a permit • Plan Chk: Dep., -
- 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 `
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. •
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. through his own employees, Mech. .
provided that such improvements are not `intended or offered for sale. I/, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden Electrical
of proving that he did not build or improve for the purpose o/ sale.) .
-
El.I,-as owner of the property, am exclusively contracting with licensed contractors to con Plumbing
strucl 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. •`Su
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ Lam exempt under. Sec.• B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
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. Ccmpany
❑ Copy is. filed with the. city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM _ REMARKS
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 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. I/, alter making this Certificate or Exemption you. should become ZONE: BY:
Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. - -
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 iaa building'permit when properly filled out, signed and'validated, and is subject to
expiration it work thereunder is suspended for 180 days. 2-28-86
I certify that I have read this application and state that -the above information is correct. Issued by: Date ' Permit
,'Iagree tocomply with all city and county ordinances and state law's *relating to building
construction; and hereby authorize ,representatives of . this' city to' enter the above-,'
mentioned property for inspection purposes. / 1 '" r Validated by:
,/
Signature of applicant { ` Date 1�
Mailing Address ! `J i Validation:
City, State, Zip #
A 4 4 6 0 2 28 6.4,.62 it
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SQ. FT.
SQ. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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. 3
J
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
�1
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
I `FINAL INSPECTION
o
CERT. OCC.
FENCE FINAL.
c%,1VAo.aiumN1uncwi Y11 AL0.
GARDEN WALL FINAL