002973 (RER)Building
Address 53 --US US AVM& DiM
Owner
Mailing
Address as abolve
City Zip
I.� Qai t a, . ( 92253.
Contractor
Address .
74-40 Vella tftv. ate 1)
City Zip -
pain Deserts CA 92M
State Lic.
& Classif. M739 8-1
Arch., Engr.,
Designer
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA.CALIFORNIA 92253
346-8864
City
Lic. # 926
No. 002973
BUILDING: TYPE CONST. TI OCC: GRP. -R-3
A.P. Number -774-041-018
Legal Description lift (►
Project Description rim c1bi3
Sq. Ft. No. No. Dw.
Size Stories • Units -
New ❑ Add ❑ • Alter ❑. . Repair ❑
Demolition ❑
Address
Tel.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
City
State
]Zip
i
FINAL DATE
Lic. #
Issued by:
Date 3/4%87 Permit
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 Business and Professions Code, and my license is in full force and
I ,( •effect. 7J I ~+ x: t i
3 23 128.72 R
I SIGNATURE DATE
„
OWNER -BUILDER DECLARATION
hereby, affirm that I am exempt from the Contractor's License Law for the.following5,
Estimated Valuation
wo
reason: (Sec. 7031.5,Buslness 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
PERMIT +A
AMOUNT -
- the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of -
,L
I Division 3 of the Business and Professions Code, or that. he is exempt therefrom, 'and the' basis -
Any Section 7031.5 'any for.
-
Plan Ghk: Dep.
for the alleged exemption. violation of by applicant a .permit
subjects the applicant to•a civil penalty of not more than live hundred dollars. ($500).
Plan Chk. Bal.
O 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. (Seca 7044, Buisness and
Cor1St.
56.50
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.
�,(t}ea
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
EIBCtrIC81
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing -
10..00
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
. S.M.I. -
X50
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec: B. 8 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. (Sic. 3800, Labor Code.)
Policy No. Companyy8.72
12
11 Copy is filed with the city. 0 Certified copy is hereby furnished./
-1'
TOTAL
k Wftft
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 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 Owrier
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.
CONSTRUCTION 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, Civil Code.)
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.
Signature'of applicant Date
Mailing Address
City, State, Zip
HARD COPY
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property. Line
FINAL DATE
INSPECTOR
Issued by:
Date 3/4%87 Permit
Validated by:
Validation,
A 7 5 8 3
3 23 128.72 R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. p
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WIRING
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO. FT.
HEATING (FINAL)
WALL SQ. FT.
REINF. STEEL
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
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
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1!/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3nc
HOUSE SEWER
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.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
DEC
7 9�7
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