001582 (RPL)Zip
M2
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No.
00.582
BUILDING: TYPE CONST. OCC'. GRP..
A.P. Number •^r�`��
Legal Description
Project Description T30 .x^Y7 +' ' f�
v
712 RX= Md.
o's0
Building
'City-
Addressi'E
Tel.
Owner
' Mailing
92234
323--7303
Address
1002 B.
City
City
. % amiuilu.. .
Contractor
& Classif:�,��
Lic. #
Sq. Ft.
Size . ..
Address .
Arch., Engr., ... _.-..".
Designer
Zip
M2
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No.
00.582
BUILDING: TYPE CONST. OCC'. GRP..
A.P. Number •^r�`��
Legal Description
Project Description T30 .x^Y7 +' ' f�
v
712 RX= Md.
'City-
Zip _ _
Tel.
+
Catbedml City
92234
323--7303
State Lic.
City
& Classif:�,��
Lic. #
Sq. Ft.
Size . ..
No. ' No. Dw.
.-Stories. Units
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) of Division 3 of the Bus! neseand'Professions Code, and -my license is'An full force and
,,effectE!.
.... .. ....
.... - .. .
SIGNATURE - . _ 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 Profession s Code: Any city or county which requires a
perrnft to construct, .alter, improve, demolish, or, repair any;•structure, •prior to its Is also
requires the applicant for such 'permit to lila a signed statement that he is licensed pursuant to...
the provisions of the Contractor's License Law, Chapter •9 "(commencing with Section 7000) oLa'.
�•
'Division -3 of.fhe Business and Professions Code, orthat..he is exempt therefrom, and r,
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. Contractor's License Law does not apply to an owner o/, property who
Estimated Valuation
..
s►
t ��%_. A�4tf_�f:
PERMIT - •
- ,. AMOUNT
-
Plan Chk. Dep.
.. - '
-
Plafl. Chk. 881.
. i w92
COnsf.
'Mach.
.. �.'7e .
- builds or improves thereon and who does such work himself or through his own employees,
.,provided than 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.) ..'�---
Electrical-
- . 2'k
s=
Plumbing
14. _W
0 I, as owner of the property, am exclusively contracting with licensed contractors to con-
r struct the project. .(Sec. -7044, -Business and Professions Code: The Contractor's License Law
w• does not apply to an owner of property who builds or improves thereon, and who contracts /or
such projects -with a contractor(s) licensed pursuant to the Contractor's License Law.)
- O I am exempt under Sec.- _-B. & P.C. for this reason "
S. M. 1.
._ +.�nw
Grading
-
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: Company
O. Copy. is filed with the city.; ❑ Certified,copy,is hereby furnished..
TOTAL
226.9
'REMARKS
CERTIFICATE OF EXEMPTION FROM
..WORKERS' COMPENSATION INSURANCE
-
-
..
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
orless.). ..
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: 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
FINAL DATE INSPECTOR'
Issued by: ¢ IdA�" Date �""2��'��P.ermit
:'•
by:
This is a building permit whenproperly 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.
agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representativey.oU this city to enter the -above-.,
mentioned property for inspection,1 purposes. /fValidated
Signature of applicant i Y `f J. Aad %.r Date
Mailing Address
Validation:
:A1731
-
6 25 22.5.84.. CK._
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL.SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
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 ® 1+/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 —ANK
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUREStlINITIALS.
GARDEN WALL FINAL