06286 (SFD)Tit,it
P.O. BOX 1504 N o . 06286
Building 78-105 CALLE ESTADO
Address 48-207 Calle Mriatas LA QUINTA, CALIFORNIA 92253 _
Owner
'be 8 Thelma Grosssaarol BUILDING: TYPE CONST. OCC: GRP.
Mailing A,
Address4� AVON— S-1 A.P. Number 617-652-004
City Zip
Legal Description
Contractor ,V- 45 ! �r r.. Project Description Tract '20052-2, Plan 2, Lot 4
Js —G.- Gasbcalm
Address l'
%%=Z 0-Hi=e 2i
Cityf: L `.a %rr i1., /a 4 /.4.Zip_/ 2 G i- G, Tel.
.1� - Rn �l22�x'�
State Lic.City
& Classif. y 5 ; 7 Lic. # 20! G Sq. Ft. 1950 No. No. Dw.
Size
Arch., Engr., Stories - Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
effect of Division 3 of the Business and Professions Code, and my license is in full force and
effec,
SIGNATURE DATE f
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following 1�,n y2$
reason: (Sec. 7031.5,Busbess and Professions Code: Any city or county which requires a y
permit to construct, aller. improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to We a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Conhactorls 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 basis - a
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civilpenaffy of not more than five hundred dollars ($500).
❑ 1, as owner of the property, w 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, Suisness and Const. 643.00.
Professions Cade: The Contractor's License Law does not apply to an owner of property who tM 1tA
builds or improves thereon and who does such work himself or through his own employees, Mech. 60.0i
provided that such improvements are not intended or offered for sale. If, however, the building t
or inprovanent is soM within one year of completion, the owner -builder will have the burden Electrical 110.83
of proving that he did not Maid or improve for the purpose or sale.) an
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 138.50
I 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. 7.07
such projects with a contracto(s) licensed pursuant to the Contractor's License Law.) Grading
❑ 1 am exempt under Sec - B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure 21270.88
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
iWorker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. r
TOTAL $3,767.36
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE _
(This section need not be completed ff the V.4 `,�41;
� permit is loll one hundred dollars (5100) valuation $� t;,-tel"rg � r ��
or less.)
1 certify that in the performance of lhg 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: dl, after making this Certificate or Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisdwrs of the Labor Code, you must forthwith
comply with such provision or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued- (Sec. 3097, CIO Code.) Side Setback from Property Line
Lenders Name
Lenders Address reOR
ECT
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work theunder is suspended for 180 days.
89
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 for inspection purposes Validated by:
Signature of applicant -- Date
Mailing Address _ __ Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES =
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE `�
YARD SPKLR SYSTEM
2ND FL SQ. Ff.
HEATING (ROUGH)
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. gQ, FT. ®
C IQK V ROUGH WIRING
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
AS (ROUGH
DRAINAGE PIPING
CAR P. SO. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
WALL SQ. Fr. ®
DRINKING FOUNTAIN
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
CU. yd.
plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
INAL INSP. —
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ® c
BATH TUB
SQ. Fr. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
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 T-
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE `�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SE
C IQK V ROUGH WIRING
DUCTWORK
ROCK STORAGE
FOUND. REINF.
AS (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.
INAL INSP. —
FRAMING _ �%�
INAL INS P r T,
ROOFING
_ C
a
v ""
/- / /-q/
'�" ` /C1 ` /
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 2
MESH
SULATIOWSOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL