002575 (GAS)44Q
• P.O. BOX 1504
78-105 CALLE ESTADO
Address 48`-731 IN-,biX'K0» S` ` t LA QUINTA, CALIFORNIA 92253
Owner Mitim p
endriakwn
Mailing .
Address.
City Zip Tel.
Contractor
. ';;�^�'t'ict'zr F31rxa�itr•.�
..Address.
State Lic.
& Classif. . 273088
Arch.,-Engr.,
Designer
Address
Lic. #
Tel.
BUILDING: TYPE CONST
A. P. Number
Legal Description
Project Description
347--36�9
10? Sq. Ft. - No. No. Dw.
Size Stories Units
New 0,; Add ❑ Alter ❑ Repair ❑ Demolition ❑
No... 002575
OCC: GRP.
M 4 a� 1 p .:
City
Zip "
State 1.
Lic. # . _.
'
LICENSED CONTRACTOR'S DECLARATION,
- v 3^ ems.:
ba 1� • 'Yti,.,m
I hereby affirm that.I am licensed under provisions of Chapter'9 (commencing with Section
7000) of Division 3 of the Business and ProfessionC gde,<and-mylicense is in'full force and
effect..ri;4 ; '' ;`..
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
- 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 :lt>
• permit.,fo construct, alter, improve, demolish, or repair,any structure; prior to its issuance -also
requires.lhe applicant for such permit to file:.a signed statement that.he is licensed pursuant to
the provisions of the Contractor's Llcense,Law, Chapter 9. (commencing with Section 7000)'of•
' Division•3'of the Business and Professfons,Code, orrthat.he is exempt therefrom; andthe basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant..for a permit
Estimated Valuation
�ay�qy ,�}�
_N^kit'iiwtd0 -
^kiiii
.PERMIT"
-
,
- AMOUNT
: Plan Chk.Dep. Dep,,.:
'
subjects the applicant to a civil penalty of not more than live hundred dollars.($500). ' .' . '
O I, as owner of the property,.or my employees with wages as their sole compensation, will
.Plan. Chk. Bal.
Con§t.
U0
do the work, 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
�Mech.
builds or Improves thereon and who does such work himself or through his own employees,
provided•fhaf' 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.for the purpose of sale.)
Plumbing "
O 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 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 contractor(s) licensed pursuant to the Contractor's License Law.)-
❑ I am exempt under Sec.B. & P.P.C.,for this reason
Grading
Driveway Enc.
Date ' owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' I hereby affirm' that' 1' have a'certificaW 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
WORKERS' COMPENSATION INSURANCE - '
REMARKS
(This section need not be completed if the permit is for one - hundred dollars ($100) valuation
or less.) .. .. _. -
certify that in the performance of thg work forwhichthis permit is issued, Vshall 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
" subject: to the Workers' Compensation provisions of the -Labor Code, you must forthwith -_
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
Side Street Setback.from Center, Line '
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
FINAL DATE
Issued by:
:Validated by:
INSPECTOR
-Date 9-45-86 Permit
Lender's Address
This'is a'building permit when properly filled out, signed and validated, andAs 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.
agree to comply With 'all city -and county ordinances and stale laws relating to building
construction, and hereby- authorize representatives of 'this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant A i fi,t ` Date
Mailing Address
Validation;
A6.343
9 15 :. 2a.00..L-
City, State, Zip r
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®
FOR. SQ. FT.®
GAR. SQ. FT. ®
CAR P. SO. FT.
WALL SQ. FT. ®
SQ. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Va c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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.
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
INAL INSPECTION
CERT.. OCC. I jr
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL