002463 (BLCK)Building
Address ss 52-035 EiSM2'X�iiVer
Addr
Owner
sooft
Mailing '
Address
City I Zip ITO
Contractor
State Lic.
& Classif. 274095
-• Arch., Engr.,
Designer
Address
City
EL
#
Tel.
P.O. BOX 1504 No. 002463
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST: OCC: GRP.
. A.P'. Number %7 '"225" 12
Legal Description T.* 1
Project Description
JSq. Ft. - No. No. Dw.
Size •Stories Units
New CR Add ❑ Alter ❑ Repair ❑ Demolition ❑
CityZip State t4–fii
_ _ Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of"Chapter 9 (commencing with Section
7000).of Division �3A,of the Business and Professions Code; and my license is in full force and
.effect. ..Ai'j(.�cr"
SIGNATURE DATE
OWNER-BUILDER'DECLARATION Estimated Valuation
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 applicant for such permit to rile a signed statement that•he is licensed pursuant to .PERMIT. � ^
the: provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3' or the Business and Professions Code, or that. he is exempt therefrom, and the basis ••
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. -Dep.
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 Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness'and COnst. r
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, Mech.
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:)
❑ 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.M.I.
• such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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.) -
Policy No. .Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
BY:
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.
' Date Owner
NOTICE TO APPLICANT: If, after making this Certificate or Exemption you should become
- Z
' subject to the Workers' Compensation provisions o1 the Labor Code, you must forthwith
M
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.) -
7 16 20.06 CY
Lender's Name
Lender's Address
FI
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.
Is
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.
V
�'- I ,1r,.. i )r i -_ r_4_
Mailing Address
V
City, State, Zip
HARD COPY
T
10.00
AMOUNT
ONE:
a
Signature of applicant ' S2Date ti
alidation:
BY:
inimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop.. Line
Side Street Setback from Center Line
Side Setback from Property Line
NAL DATE
INSPECTOR
sued by:
Date -7-16-86 Permit
lidated by:
A5973
7 16 20.06 CY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
-$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX: HEATER OUTPUT, B.T.U.
SQ. FT. RESID a 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
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 GOND. 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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH {�
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL