002862 (3&4)Building 55-423 tC3M
Address
Owner
Mailing -
Address y
City
'
Contractor
Address . -
Sam
City
State Lic.
& Classif.• 288130
Arch., Engr.,
Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Zip Tel.
92260 515R 2282
Zip Tel.
City
Lic. # M
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 theBusiness and Professions Code, and my license is in full force and.
effect. . vF ... r•
SIGNATURE d a LFr- * "- 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, alter, improve, demolish, or repair any structure, prior to its issuance also
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 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 a'civil penalty of not more than five hundred dollars ($500): •"
❑ 1, as owner of the property,, or my employees with wages as their sole compensation, will
do the work, and the structure isnot 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
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
of proving that he did not build or improve for the.purpose of sale.)
O 1, 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) licensed pursuant to the Contractor's License Law.) -
0 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that Ihave a certificate of consenttoself-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 (5100) 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. ir
�. „ .
Signature of applicant e .r a'•—� Date
Mailing Address (-sL
City, State, Zip
No. 002862
BUILDING:. TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description Pte. I PHAM 14 B
PM 20 OR
5096?
Sq. Ft. 2- No. No. Dw.
Size _577Stories Units
New ® Add ❑ Alter ❑' Repair ❑ Demolition ❑
Estimated Valuation $ 17991318.04
PERMIT
Plan Chk. Dep.
Plan Chk..Bal.
Const..
Mech.
HARD COPY
T
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
525.1
633.00
555.A00
.7,-.5.-.7 .06 I
132.50
12.5
2,000.00
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 1-27-87 Permit
Validated by:
Validation:
A 7 2 1 3
1 30 547123 Ch
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FFA&
NO. PLUMBING FEES
IST FL. SO. FT. ®
UNITS
COLL. AREA
t,�AeSLAB GRADE Z �O —�1
UGH PLUMBC/-7�a /—O 7
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. S0. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SO, FT.
DRINKING FOUNTAIN
SO. FT. ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
—cu. yd.
plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
INAL INSP. „�
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
�—lo
�!.`e U (N�''��/ L�—� Q
lI ,�JaGC r1/✓� • ( L� 31J—.i%
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
e4lCf-ATHING C.�-�t✓-- ,
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
&INSULATION/SOUNDLI
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
TNST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
6,��WETBACK —a'� 6—ri
ROUND PLUMBAG
UNDERGROUND
A.C. UNIT
COLL. AREA
t,�AeSLAB GRADE Z �O —�1
UGH PLUMBC/-7�a /—O 7
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SE5 �K
UGH WIRING/ /—" '
DUCT WORK
ROCK STORAGE
OLIND. REINF.� _�i^ �7
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
✓� EINF. STEEL2 —�� %�/
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
—cu. yd.
plus x$
_$
LUMBER GR.
ONAL INSP.
JeRAMING ('/ �(—S/
INAL INSP. „�
Fi00FICJrI/C 3�
�—lo
�!.`e U (N�''��/ L�—� Q
lI ,�JaGC r1/✓� • ( L� 31J—.i%
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
e4lCf-ATHING C.�-�t✓-- ,
MESH
&INSULATION/SOUNDLI
FINISH GRADING
eZ.&MMAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL