002495 (BLCK)Building
Address
Owner
Mailing
Address
City
I Contractor
4
P.O. BOX 1504
53-- 793 AveTI3da F3% LA QUINTA CALIFORNIA 92253
ress .
sam
Zip
State Lic.
& Classif.. 317x401
Arch En r ..
No. 002495
BUILDING: TYPE CONST. OCC: GRP:
A.P. Number 4— 01
Tel.
Legal Description lift 2
Project Description
Tela
City
Lic. # � � , Sq. Ft. 80 lin� ftNo. No. Dw.
Size StoriesUnits '
Designer
New m: Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
_
Lic. #
fCf' }il - WWd-. ftnae
LICENSED CONTRACTOR'S DECLARATION_._ _
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license'i's iii full force and
'effect.. �
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for.the following
� n
765*"r
reason: (Sec.. 7031.5,Busine,ss and Professions Code: Any city or county which requires a
I�
-
" permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for: such permit to lila a signed statement that he' is licensed. pursuant to ='
-PERMIT
-
AMOUNT
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 Any Section 7031.5-by'any for
Dep.
alleged exemption. violation of applicant a permit
'subjects the applicant to a civil penalty of not more than live hundred dollars ($500). •"
.Plan,Chk.
Plan Chk: Bal.
. O 1, 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
Corlst.♦
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.oflered for sale. If, 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 of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
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.
such projects with a -contractors) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am 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. Company
O Copy is filed with, the city. O Certified copy is hereby furnished.
TOTAL„(}
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS'COMPENSATION.INSURANCE
(This section need not be completed it 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: if, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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
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.
7--24-86
1 certify that I have read this application and state that the above information is correct.
Issued by:
Date Permit
I agree to comply with all'city.end 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.' J
w
Validated by:
Signature of applicantl Date J7/
Mailing Address
Validation:
City, State, Zip
A6..03)i
_�. 24 20.00 Ch
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ 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.
SQ. FT. ® c
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1'A c
SEWAGE DISPOSAL
SO.FT.GAR ® 3lac
HOUSE SEWER
FINISH GRADING
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.IEQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL