003429 (BLCK)Building
Address 45-525 WASUING
Owner
. ARMNY Sit JAI+'
Mailing
Address SIM
4
P.O. BOX 1504
78-105 CALLE ESTADO
y�y LA QUINTA, CALIFORNIA 92253
City Zip Tel.
. :. .LA QUIM.. 92253 564-aW33
Contractor
'OMRAMDER
Address
az ?�
City. lZib ITel:
BUILDING:.,TYPE-CONST. OCC: GRP:-
A.P. Number.
Legal Description
Project Description ' z MCK V= 6 #HXGH X 50" LONG
State Lic.
City
& Classif..
Lic. #
Sq.'Ft.
Size
No. _ No. Dw. ry
Stories Units
-Arch.' Engr:, _.:. .
Designer
New ❑• Add ❑
Alter -0 Repair ❑ 'Demolition ❑
Address
Tel.
City
Zip
State
Lic.'#
LICENSED CONTRACTOR'S DECLARATION
n '
-1 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 '
effect.
, ,
.. • , - .
_SIGNATURE DATE
"OWNER•BUILDER DECLARATION,Estimated
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 applicanvforsuch permit to file a signed statement that he is, -licensed *pursuant to -
• the provisions of the Contractor's License Law, Chapter 9 r(commencing with Section 7000). of •
Division 3 of1he Business and Prdfessions Code_or-thaC6e-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 compensation, will _^
do the workp and the structure is not intended or offered for sale. (Sec: •7044, Buisness and
Professions ,Code: The Contractor's License Law does not *apply to ,an owner of property who
VaIUatlOn. ,
nd50 00
•
PERMIT
- AMOUNT
Plan Chk. Dep.'
Plan Chk. Bal.
TA '40 -
COnSt. '
Mech.
-
-
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.
_
Electrical
- or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve tor,the purpose of sale.) . ..
Plumbing .
❑ 1, 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.Law
does not apply to an owner of property who builds or improves thereon, and who contracts for* 5
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
O I am exempt under Sec. - B. t+ P.C. for this reason
Grading
..
Driveway Enc.
•-
Date / - -'< Owner -� - i fx'
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. ❑ Certified copy is hereby furnished.
TOTAL
Teo
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE . .
REMARKS
'•
(This section need not be completed if the permit is for .one hundred dollars (S 100)' valuation
or less.) ..... .. ... .. .. ...
I certify that in the performance of thg work for which this permit is issuedi I shall not
employ any person in,any manner so as to become -subject to the Workers' Compensation
Laws of California. - ..
_
45 M: j ' .699 .:_ ,{ "-,0 8:
s.�r "..w=ss[s s v v::-�e« x o.wvzzsv
Date"' "' Owrier'
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
'subject to the Workers' Compensation provisions of the Labor Code, you must 'fohhwitri'
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
CONSTRUCTION LENDING AGENCY .M
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 Street Setback from Center Line
Side Setback from. Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed-a4validated; and is subject to,
expiration if 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..
FINAL.DATE
Issued by:
Val (dated by:
INSPECTOR
Date .1016/,97. Permit
"
Signature of applicant Date
Mailing Address
Validation:.
City, State, ilp
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ, FT, ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. 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 APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMPUS 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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 14/4 c
SEWAGE DISPOSAL
'
SQ.FT.GAR @ 3/ac
HOUSE SEWER
REMARKS:
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 APPJEQUIP.
S
AS (FINAL)
TEMP. POLE
G OUT
WATER HEATER
SERVICE
FINAL INSP.
D BEAM JC)
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
'
��� 7 198 (%p
7
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