002586 (BLCK)P.O. BOX 1504 N Li
Building t 78-105 CALLE ESTADO
Address' 52-,-637_Avwdda V111a LA QUINTA, CALIFORNIA 92253
Owner.. - ..... .. ... .. .... .... .... .. .. .. .. , .. .. ,_ .
BUILDING: TYPE CONST,
Mailing OCC:.GRP. -
Address A.P. Number
CityZip Tel.
Inta 12253 4_2' Legal Description
Ta 12.
Contractor - Project Description
Address'
-city -.. Zip' TeL`
State Lic. City
& Classif. • . • Lic. # Sq. Ft: No. No. Dw.
Size. Stories, Units
Arch:, Engr:; _ .
-Designer " New 0X,1 Add ❑,.- Alter -O.., :- Repair ❑ '--Demolition ❑•,.
Address Tel.
City Zip State - 27 Ike rof a
Lic. # '
' LICENSED CONTRACTOR'S DECLARATION.. - t. 43 fk• 'd 4 Aidt h.0h b -lock.
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section.
70 00'
of Division 3 of the Business and Professions Code, and my license is in full force and
effect. '
SIGNATURE DATE. .. _.. ..
OWNER -BUILDER DECLARATION Estimated Valuation
=1 hereby affirm that I am exempt from the Contractor's License Law for the following `%AZ.�s� - '
,.reason: (Sec. 7031.5,Businass and Professions Code: Any - city or county • which requires a.
permit to, construct, alter, improve, demolish, or repair aby structure,' prior to.itsissuance also • • • ++ .
requires .the applicant for such permit to file a signed, statement that. he is licensed: pursuant to. >a' •"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- bans ,`.Plan Chk. De
for the alleged exemption. Any violation of Section. 7031.5 by 'any applicant, for a permit p •' - ''�
'subjects the applicant to a civil penalty of.not more than five hundred dollars ($500). .:. ' .". • I`%, .
.O I, as owner of the property,, or my employees with wages as,their sole. compensation, will - Plan, Chk. Bal. ;
do the work; and the structure is not intended or offered for sale.'(Sec. 7044, Buisness and • Cpnst.. ISS
&i Code: The Contractor's License Law does •not apply to an' owner of -property • who ISS&i iii .
builds or improves thereon and who does such work' himself or through his .own employees, Mebh. •- - - ..
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 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:Ma.
such projects with a contractor(s) licensed pursuant to the Contractor's License -Law.) '
.... Q ' -I am exempt under Sec.. B. & P.C. for this reason Grading
f Driveway Enc.
Date Owner 'y�*r!'- -A- Infrastructure
s.- -
WORKERS' COMPENSATION DECLARATION
'I hereby affirm that I have 'a *certificate 'of consent to self -insure, ora certificate oft.
Worker's Compensation Insurance, ora certified copy thereof: (Sec. 3800, Labor Code.)
Policy No. ... -. Company
O Copy is filed with the,city. , 0 Certified copy is hereby furnished. „
TOTAL UU.J5
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation '
-or less.) ., .. .. .. ..
(.certify that in the performance of the work for which this permit is issued, I'shall not - ;J..
I
any person in anymanner so as to become subject to the Workers' Compensation '
i
Laws of California. .. -
Date Owriei
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 MIf111TIUm Setback Distances:' '
comply with such provisions or this permit shall be deemed revoked. - -. -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center.Line'" '
1 hereby affirm that there is'a construction lending 'agency. for the performance of the
work for which this perm_ it is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line -
Lender's Name i
Lender's Address
This is a building permit when properly' filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 clays.:'.. - 9-'24-86
I.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 and county ordinances and state laws relating to building':
construction, and hereby authorize representatives of . this city to • enter the above-.
mentioned property fors inspection ppurposes. _ Validated by:
Signature of applicant 7 �f_.. s ^ , _ f, A ,r -"t Date `
Mailing Address
- -
•"`Y Validation:
City, State, Zip _
A 6 3 8 2 9 Z4 'k .113.55 ,U
- HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CAR P. SD. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR ::iivK
ROOF DRAINS .
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
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
/
(/
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.
SQ. FT. ® c
BATH TUB
BOND BEAM t'n
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
LUMBER GR.
SQ.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. /v
/
(/
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM t'n
f
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
V
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