001763 (RPL)Building
Address
Owner
P.O. BOX 1504 NO. :001763
44-421 W. Dxxbwn CkVft U. LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST.. OCC: GRP
Mailing
Address Stlite 27
City IUIU �
Zip Tel.
J.L. CM—Sti—MICAUM
Contractor
—Address
74-30 EW M Witte L
.."City , . . _ . Zip, .. . Tel:
A"P. Number 613-421-003.'
R _ , Legal Description Tracti99-03 •
Project Description Pool *Aade
State Lic.
City
& Classif: 442822
Lic. # 237
Sq. Ft.
Size 216.1...
No. No. Dw.
Stories Units
- Arch.,' Engr.,. .... ..... .
Designer
New ,p Add ❑
Alter ❑• Repair ❑ Demolition ❑
,..,. Address
Tel.
City
Zip
State
Lic. #
• LICENSED CONTRACTOR'S, DECLARATION.
'•
hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section -
7000) of Division.3 of the Business and P,rofessio. s Code, and my license is in full force and ' •^
effect. A /%f i f f + *YA�y
..
.. ,. . . .. .. .. ..
SIGNATURE i!". ,. �.-•.P__- v � W'-%sJv".-v',�' •! DATE
" OWNEWBUILOER 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, 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
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).'
❑ I; as owner of the property, or my employees with wages.as their sole comp ensation,,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 -apply to an owner of property who ;-
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
orimprovementsold 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.)
Estimated Valuation
'-
�1t�� p/�
2�3. aJ
PERMITAMOUNT
,•
zr• - '
' • - -'-
. Plan. Chk. Dep.
. . •
PlanChkBal
_
.25-4.2
COf1St..
-50
MecM.
-.
Electrical
,
'
Plumbing
-
❑ I, as owner of the property, am exclusively contracting with'Iicensed 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 pursuanhto the Contractor's License Law.) - -
0.l.am exempt under Sec.. B: ti PIC. for this reason -
S,M.I'. - •
d
', �,�
Grading
-
Driveway Enc.
..
Date Owner
Infrastructure
' WORKERS' COMPENSATION DECLARATION
' I'h"ereby affirm that I have a certificate of conserit 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
64.02
_
- CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE.. _
REMARKS
(This section need not be completed if the permit is for one hundred dollars. ($100) valuation
.or less.) . _ ..
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
NOTICE TO APPLICANT: If, after making this Certificate or 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
coNsrRucnoN LENDING AGENCY
I hereby affirm' that there is a'construction lending •agency for the performance of then
' work for,which this permit is issued.,(Sec: 3097; Civil.Code.)- - _
Side Street Setback from'Center Line '
Side Setback from Property. Line
Lender's Name
FINAL DATE
Issued by:
Validated by:
Validation:
A.30.2Q....-1R_.3064,•6-.2
INSPECTOR „
Date 10"'25 85!Dermlt .
Cti
Lender's Address
This is a building permit when properly filled out; signed and validated, and is subject to'
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state..thar the above information is correct.
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., ' f ' '
Signature of applicant r r fi a:tt-'i_ f,"6'�A 1 r4kr%f Date
Mailing Address ``i wy�� � d~ `- 'Y ` "/.
City, State, Zip 1
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
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.IEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN 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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
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-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 SIGNATURESIINITIALS•
GARDEN WALL FINAL