003032 (ELEC)44
P.O. BOX 1504 No. 003032
BuildingA 78.105 CALLE ESTADO
1
Address 53-1:8 njitmi1 A LA QUINTA, CALIFORNIA 92253
Address P. 4. BM 1702
CityZip Tel.
P ' ;>�ewrt - . 9220 ' l 345-7352
Contractor
Richard Gitve'+r Const) -tion �:
Address
P. 0. B= 702
City JZip Tel.- '
Pari De
S_er 92261 345-7352
State LID. City
& Classif. 673053 Llc, # 784
Arch., Engr.,
Designer
Address Tel.
City Zip State
- LID. #
f LICENSED CONTRACTOR'S DECLARATION !
'I'lie'
t that I am licensed under provlelone of Chapter9 (commencln0 with Section
7000) o}.Dlvlslon 3 of the Buelne'a and Professions Code, and my license is In full force and
effect, r . / . l .I t - ;'!4 -
RID ATl1RE - DATE
a OWNER•BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Suslness 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 rile a signed statement .that he Is Iicensod pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Sualness'and Professions Code, or that.' he.is-exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by' 'any' aappplicant 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, Bulsnese and
Professions. Code: The Contractor's License Lew does not apply to on owner of property who
bullds or Improves thereon and who does such work himself or through his own employees,
provided that such Improvements are nor 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 dld'not build or Improve for the purpose of cele.)
❑ I,.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 Lew
does not apply to an owner of property who builds or Improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑.I am exempt under Sec. B, & P.C. forthis reason
Date Owner
WORKERS' COf PENSATION DECLARATION
I herebysafflrm thatJ.ha4e a;cooiflcate of consent to-self•insure, or a certificate of.
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3500, Labor Code.)
Policy No. Company
❑ Copy Is filed.with the city. ❑ Certified copy Is hereby furnished. ..
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit is,for one hundred dollars ($100) valuation
or less.) -•
Icertlly that In the performance of the work for which this permit Is Issued,.l shell not
employ any ppereon In any manner so as 4o become subject to the Workers' Compensation
Lewe of Cellfornla.
'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.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there Is a construction lending agency for the performance of the
work for which this permlt 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 If work thereunder Is suspended for 180 days.
I certlly that I have read'thie 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
Mclling Address
City, State, 21p
HARD COPYI
BUILDING: TYPE CONST. I I OCC. GRP.
A.P. Number r74-042-007
Legal Description
Project Description Temora29 s'd1; dr .Pole
Sq. Ft.
Size
No. No. Dw,
Stories ' Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
3'
Plan Chk. Dep.
Plan Chk. Bal:.
*20.00
Const.. "
Mach.
Electrical
Plumbing
S.M.I.Q
Grading
Driveway Enc.
Infrastructure
TOTALxJ.5C#
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 4/7/87 Permit
Validated by:
Validation:
B7697 4. .3, SG it
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING F&S
1ST FL. SQ. FT. $
UNITS
of '
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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.
SO. FT. ® c
BATH TUB
LATHING
SO. 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
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 APP./EQUIP.
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
c
DEC 17 10
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL