002964 (BLCK)4
Tr #19903, Liii Qxinta Palm 78 1 5 CAIO E 504 No. 002964
Address'
LA QUINTA, CALIFORNIA 92253
Address �'"'2r3g � �'� D3,^3.�. .. ., .. .. -.
Owner
PM Amfficm Land DeVolopmMt., I=.
Mailing
Address � � AVMW,r SUite H
City Zip Tel.
P1zAmnt4 92670 (710- 996-2000.
Contractor
Aclaims MotX03;;i :fie
Address
ILDING: TYPE CONST. OCC: GRP.•
P., Number
Legal Description
Project Description*hatb&ElItXY Gam'$ fcw
ta Q� Ellaim
41-910 Boardo JS -4
cit
Palm .ate
Zip
92260
Tel. 56 78
State Lic.
& Classif. 286088 ®,D
City
Lic. # 648
Sq. Ft.
Size
No. No. Dw.
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑. Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. # _ ..
. LICENSED CONTRACTOR'S DECLARATION
I 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.
t - Y`
,.•
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 a
- permif to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
I- requires the applicant for such permit to file a signed statement'that he is licensed pursuant to
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 it 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 ❑ I,_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
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, .
provided that' such improvements are not intended or offered for sale. If, however, the building
i 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.).
❑ 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 -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec.. B. 8 P.C. for. this reason
Estimated Valuation
-
PERMIT
-
AMOUNT
-
Plan Chk. Dep..
. 87.42
' Plan CWBa l'
Const.
'�'�/�,
•+�.rs�5c0
�
Mech.
'
Electrical
'
Plumbing
S.M.I.
- 1.30
Grading
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
1 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.)
t.Company
7< 0,.Copy is filed with the city. ❑ Certified copy is hereby furnished.
"
�^lPolicyNo.
-- ^
TOTAL
Y
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if 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
employ any person in any manner so as to become subject to the Workers" Compensation
Laws of California.] ^V� L
Date' Owner
NOTICE TO APPLICANT. If, after making this Certificate of, Exemptioh<.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.
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.)
Lender's Name
Lender's Address
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:
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.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
REMARKS.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from. Property Line
FINAL DATE INSPECTOR
Issued by: Date 2/27/87 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROUGH WIRING
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SO. FT. ®
HEATING (FINAL)
WALL SO. FT. ®
REINF. STEEL
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
LATHING
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./EQUIP.
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
u
EC
Iwo
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