002872 (3&4)Building 5.r,,.M pjMS
Address
Owner
sits im
maning
Address 75—on ociuft
City lZip
Contractor
Address
swaa
State Lic.
& Classif. 28aJ30
a
44
P.O. BOX 1504 No. 002872
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
Drive A.P. Number
Tel.
568-2828 Legal Description
Project Description PM V=r PEM 14 8
P11a -10 OR
Lic. # 328
Arch., Engr.,
Designer
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. /.-F� -'1 -'' wr i r4.!'� :.._•'A• `r' f,
I 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
permit to construct, after, 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
j 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 is exempt therefrom, and the basis
i for the alleged exemption. Any violation of Section 7031.5 .by 'any applicant for, a permit
subjects the applicant to acivil penalty of not more than Ove hundred dollars (8500).- '
❑ 1, 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 •..
I 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
or improvement is sold within one year of completion, the owner -builder will have the burden
I of proving that he did not build or improve for the purpose of sale.)
O I, 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
i 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.) - -
❑ 1 am exempt under Sec. B. & P.C. for this reason
j
Date Owner
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.)
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 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
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.
- 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 tr �s r• t Date
Mailing Address
City, State, Zip !
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 1.,47" 87 Permit
Validated by:
Validation:
A7LCO 1 3U 336291 Cn
HARD COPY I
T
2272
Sq. Ft. 552
Size -
No. No. Dw.
Stories Units
New Aird ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
S MAMA()
PERMIT
AMOUNT
Plan Chk..Dep.
Plan Chk. Bal.
485.64
Const.
Mech.
55.00
Electrical '
102.27
Plumbing
128.50
S.M.I.
11.10
Grading
Driveway Enc.
Infrastructure
2,000.00
TOTAL
3,352.91
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 1.,47" 87 Permit
Validated by:
Validation:
A7LCO 1 3U 336291 Cn
HARD COPY I
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL E151111ft.
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
NEW
UNITS
yGGSLAB GRADE
ROUGH PLUM?
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
STORAGE TANK
FORMSCSEWER
OR SEP '}
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
FOUND. REINF.
GAS (ROUGH)
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
OTHER APP./EQUIP.
![/41EINF. STEEL '—v—q
DRAINAGE PIPING
CAR P. I SO. FT. ®
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
BOND BEAM
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
0 ROOFING L _-q -,
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
s, a-�,�
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
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. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 S� 7
ROUND PLU N&
UNDERGROUND
A.C. UNIT
COLL. AREA
yGGSLAB GRADE
ROUGH PLUM?
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSCSEWER
OR SEP '}
OUGH WIRING /,
V
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
![/41EINF. STEEL '—v—q
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP./ 6) c6
J (l
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
FINAL INSP.
FRAMING
(
Gj�fNAL IN$P.�Jam`
JV
0 ROOFING L _-q -,
t (N
a j
�
s, a-�,�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
FIREWALL
�Jt,c� AGAR.
,,,ATHING �-
MESH
T INSULATION/SOUND 5
FINISH GRADING
gC`�NAL INSPECTION J G
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL