04800 (MFD5)-- . , - ` • � ------------
0000
P.O. BOX 1504
Building w. 78-105 CALLE ESTADO
Address , 55 ,5,22 Firestone LA QUINTA, CALIFORNIA 92253
Owner -
" '{tmlz''ae Company BUILDING: TYPE CONST. OCC. GRP.
' Mailing'
Address '75.,;IPS fv''OL' retry ty tub DriV`t'� „ _ PGA 'Kest ti'h,� Greene -
A.P. Number'
City - ., ' • �• P Tel.
61n, , 226� 6�- 2 2#3 Legal Description
Contractor Phase OBC Plan 2
National Jolortgag® Project Description
Address _
slue
City Zip Tel.
State Lic. 288130 City 328
& Classif. Lic. # - ' - - Sq. Ft. 1700 No. NO`DW.
Size Stories Units
Arch:, Engr.,
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
7000) of Division 3 of the Business and Professions Code, and my license is in full force,and
effect.._ a ! ✓ ' .✓�} -' I f # / �; ; l , t t
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractors License law for the following $1�a ��$
reason`..(Sec. 7.031.5,Susiness 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 PERMIT AMOUNT
the provisions or 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
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). r+ 401,27 tf y `!
0 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. y/ Y V • 2 f
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 or property who t� Yui t�
builds or improves thereon and who does such work himself or through his own employees. Mech. 33wii V
provided that such improvements are not Intended or offered for sale. If, however• the building 3
or Improvement Is sold within one year of completion, the owner -builder will have the burden Electrical 72.50
of proving that he did not build or improve for the purpose or sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to coo- Plumbing 105.00
slruct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law c3 ♦ /
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 8.44
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure $2,717.31 1r"�� •�
Loss Credit 11358.66
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
❑ Copyis filed with the city. O Certified copy is hereby furnished.
11 TOTAL 62,470.37 1 dcl ff ),
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This sec0on need not `be completed if the permit is' for one hundred dollars ($100) valuation 'N"'� •� t f�i S � �i` ! �s ski' Y —��} rtf • `s r
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any parson 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 ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's,Addresis FINAL DATE—INSPECTOR' �.
This is a building permit when properly filled out, signed and validated, and is subject to11/15/88
expiration it work thereunder is suspen ed for 180 days.
I certify that I have read this applicati n and state that the above information is correct. Issued by: Date Permit
I agree to comply with all city and coun ordinances and state laws relating to building
construction, and hereby authorize rept entatives of this city to enter the above-
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
WHITE - FINANCE, PIN APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
:S NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASH ER(AUTOYDISH)
GARBAGE DISPOSAL
LAUNDRYTRAY
KITCHEN SINK
WATER CLOSET
LAVATORY
SHOWER
BATH TUB
WATER HEATER
SEWAGE DISPOSAL
HOUSE SEWER
GAS PIPING
PERMIT FEE
ECT. FEE SMI FEE PLUMB FEE
HEATING 8 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.IEOUIP.
REINF. STEEL
(FINAL)
TEMP. LE
GROUT
WATER HEATER
VICE
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
INSULATION/SOUND
FIN H GRADING
&IN�AL INSPECTION
IF
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL