002082 (CCOM)Building
Address
Owner
�t;7.=AJW
Mailing
Address peo, FJ= 519
City I Zip ITel.
Contractor
Address .. P.,
...
Pnx '2
City " ' Z
.�
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tela
962#-1 564-2228
City
Lic. #
el.
No. 002082
BUILDING: TYPE CONST. i OCC. GRP.
A.P. Number/�� iv " 0-0
Legal Description
Project Description
Claw=qd'Oarpwt
Sq. Ft.14 No. No. Dw.
Size Stories Units
New 14 Add ❑ Alter ❑. Repair ❑ Demolition ❑
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions.obChapter 9 (commencing with Section'
7000) of Division 3 of the Business and Professions'Code, and my license is in full force and
effect 1i`.i'''.:,/l•f� • .�`.t�al.,.�•' + %',�,/`L'f;rr;°•
SIGNATURE d \ DATE .
J OWNER=BUILDER DECLARATION EStlr
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
ed Valuation
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 Vol the Business and' Professions Code, or that. he is exempt therefrom, and the basis
- PERMIT
Plan
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant-. for a permit
Chk. Dep.
subjects the applicant to a civil'penalty of not more than five hundred dollars ($500). -
Plan Chk. Bal..
❑ I, as owner of the property, or my employees with wages as their. sole compensation; will
Side Street Setback from Center Line
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
Professions Code: The Contractor's License Law does not apply_to an owner of property who
FINAL DATE
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
Validated by:
or improvement is sold within one year of completion, the owner -builder will have•the burden
Electrical'
- orproving 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 contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
O I am exempt under.Sec. B: 8 P.C. for this reason
Driveway Enc.
Date Owner
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 certified copy thereof. (Sec. 3800, Labor Code.)
Policy No.' Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
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 th0 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 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.
I 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 subjectto
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. // 1
Signature of applicant �t �} ilr /� Date'"
Mailing Address fi
City, State, Zip f
HARD COPY
Infrastructure
TOTAL
REMARKS
12. 720.00
AMOUNT
W/.9i
144.50
•95
-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 2-25-86 Permit
I
Validated by:
Validation:
A 4 3 9 9
2 25 73,37 it
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. I SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE'ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® vac
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 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
y/
REMARKS:
VENTILATION
FIRE'ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR: FIREWALL
,
LATHING
MESH
'
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL