002841 (RER)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 48-890 atm LA QUINTA, CALIFORNIA 92253
Owner y�i13.f,�,s r - .. •
No. 002841
BUILDING: TYPE CONST- OCC. -GRP.
Mailing"
Address �5s30 � St, 631-321--002
_ A:P. Number
City Zip Tel.
92236 -.%,d .36 3 Legal Description 106
Contractor Project Description
Address
State Lic.
& Classif. 1927"
Arch.; Engr.,
Designer
Address
I'1ty
Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
el.
City IZip I State
Lic. #
LICENSED CONTRACTOWS.DECLARATION,
I hereby affirm that I am Iicensed.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
effecI.
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,Buslness: and Professions Code: Any city or county which, requires :a.
Perrin to construct, alter. Improve, demolish, or repair any structure, prior to Its. Issuance also.
requires the applicant for such permit to file a signed statement that heels licensed pursuant to.
the provisions of the Contractor's License Law, Chapter g (commencing with Section 7000). of
Division 3 of the Buskfess'and Professions'Code, or that:he Is exempt therefrom,- and the:basts `
for the -alleged exemption. Any violation of Section 7031.5 by 'any - applicant for a permit
subjeots.fheapplicant to a civil penalty ofnot more than five'hundred dollars ($500). -
❑ I, as owner of the property, or my employees with wages as thelr_,sole compensation, will
do the work, and the structure Is not Intended or offered for sale. (Sec. 7044, Bulaness and .
Professions Coder The Contractor's License Law does .not apply to an owner ofpropertywho
builds or. knproves 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
or Improvement is sold within one: year of completion, ,the owner -builder will have the burden
of proving that he did not bulld or improve forrthe purpose of sale.) - 01'
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) ficensed,pursuent to,the.Contractor's License Law.)' -
❑ 1 am exempt under, Sec: B. & P.C. for this reason
S
Dates Owner r d 1•��.r r
WORKERS' COMPENSATION DECLARATION
I' hereby affirm that I have a certificate 'of consent to -self -insure; or a certificate of
Worker's Compensation Insurance, or a certitied copy thereof: (Sec. 3800, Labor Code.)
'Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one' hundred dollars (5100) valuation
or less.) . _ ..
I certify that In the performance of the 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.
Date -, Owner
NOTICE TO APPLICANT: "h 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.
CONSTRUCTION LENDING AGENCY
1hereby affirm that there Is a construction lending agency fowthe,performance of the,
work for:whichRhis permit is issued. (Sec. 3087; 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 workthereunder is suspended for 180 days. -
I certify that I have read this application and state that the above information Is, correct.
1 agree to,comply with all'bity 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 1
City, State, Zip
HARD COPY
New ❑ Add ❑ Alter 19 Repair ❑
Demolition ❑ .
Estimated Valuation.�get��.
PERMIT AMOUNT
Plan Chk. Dep.,
Plan Chk. Bal. 25„02
Const. -32.5a
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL 64.02
REMARKS
ZONE:
BY:
.Minimum Setback Distances:
Front Setback.from Center -.Lin
Rear Setback from.Rear Prop. Line
Side Street Setback from Center Line '
Side Setback from Property. Line
FINAL DATE
INSPECTOR
Issued by:
Date 1-15-87 Permit
Validated by:
Validation:
A 7 1 2 0
1 15 61�L2 3
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SQ. FT. ®
OTHER APPJEQUIP,
REINF. STEEL
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN
SO. FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/4c
HOUSE SEWER
MESH
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
FINAL INSPECTION
CERT. OCC.
FENCE.FINAL
INSPECTOR'S SIGNATORESIINRUILS.
GARDEN WALL FINAL