002988 (BLCK)i
44
P.O. BOX 1504
No. 002988'
Building
Address' �e LA QUINTA, CALIFORNIA 92253
'
Owner
Keith Am Palmw BUILDING: TYPE CONST. - OCC: GRP:
'Mailing
Address_ 73-08 Wick Sprinp Drive A.P. Number 617-111-004
City Zip Tel.
-pailm . sto CA, . 922.60 34 643 Legal Description
Cto- trractor Project Description 1.0-0 o ,4t'". H BIC&, 3.l
Address Side, of 0
City Zip.' Tel..
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
-Stories Units•
Arch., Engr.,
Designer
Newer Add ❑
Alter ❑- Repair ❑ Demoli.tion ❑
Address
Tel.
City
Zip
State
Lic. #
.. .. . LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter (commencing with Section
" 7000) of Division.3 of the,Business4nd Professions Code, and my license is in full force and '
. effect: + R41 —Ca A c�,'�.h. ,s. , :. ? [ 1 ! �/
�• " •"
SIGNATURE DATE•
_ " _
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for" the following'
Estimated V2IUatlOfl
Ar
reason:, (Sec. 7031.5,13usiness and Professions Code: 'Any ,city or .county which requires a
-
..
to
permit to construct, alter, improve, demolish, or repair. any structure,: prion to its issuance also
-
- -
requires the applicant for such permit to, fife a signed. statement that -he is 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 tie basis
_.
- for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit -
-Plan Chk.. Dep..
-
subjects the applicant to acivil penalty of not more than five hundred.dollars ($500).
Plan, Chk. Bal.
�3l1
GiIA€
�.i
O 1, as,owner of the property, or my_employees with wages at their sole compensation, will
-
do the work, and the stricture is not intended or offered for sale..(Sec. 7044, Buisness and '
Const. '
_
��rrtr
- . 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 offered, 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 ofsale.) -
❑ 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:l,
- X50
• • such projects with a-contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
"
- - 11. I 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, ora certified copy thereof- (Sec. 3800, Labor Code.)
'
Policy No. Company
❑'Copy, is filed with the city. O Certified, copy is hereby furnished.
TOTAL
s
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
- -
. or less:) ,
- -
I certify that in the performance of thg work for which this permit'is issued, I shall not
r
employ any person in any manner -so as,to become subject to the Workers" Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT:N, after making this Certificate of Exemption you should become
I '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
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.)
Lenders 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 iof this city to enter. the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing.Address
City, State, Zip
HARD COPY
Rear Setback.from.Rear Prop. Line
Side Street Setback.from Center Line`
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by,: Date 3/12/67, -Permit
Validated by:
Validation:
B7518 3 12' 51.65 it
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. S0. FT.
WALL SO. FT. ®
SQ. FT. p
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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
��
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/ac
HOUSE SEWER
$
GRADING
cu. yd.
plus x$
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
///
�OLIND. REINF. �_ 4�
✓
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.
eROOFING
��I N/nt CL
N LI c3L p 1 "� ��/
DEC 17
198.7FINISH
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
t4eLATHING i
MESH
INSULATIONISOUND
GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL