05245 (SFD)4
P.O. BOX 1504
Building 7&105 CALLE ESTADO
Address 48-131 Via Hermosa LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 9010 Corbin Aire.. Bunte "3,
CityTel.
Zip
Horthridsze 913284 181844
Contractor
77--200 Kinsesots "" .. .
city Zip TeL
Pali& :nanert 92260 345
State Lic. City
& Classif_ 10 1% Lic. #
Arch.,. Engr.,
Designer
Address I Tel.
City(Zip I
State
Lic. #
iC LICENSED CONTRACTOR'S DECLARATION
1 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
P
effect ,r'•
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.SIGNATURE .,•-,M,• « r'!' '.P'S.� DATE
OWNER -BUILDER DECLARATION rr
Thereby affirm that I am exempt from the Contractors 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, pdor to its issuance also
requires the. applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License law, Chapter 9 (cormmencmg 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
.
sifted the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, 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, mess 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. fl, however, the budding
or improvement is said within one year of completion, the owner -budder will have the burden
o/proving 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-
struct the.project (Sec. 7044, Business and Professions Code: The Contractors 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.)
❑ I am exempt under Sec B. & P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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'COMPENSATIONINSURANCE
(This section need not be completed if the pemdt is for one hundred delays ($100) vahntion
or less.)
1 certify that in the performance of the 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
N077CE TO APPLICANT.' ff, after making this Certfycate of Exemption you should become
subject to th Workers' Compensation provisions of the Labor Code, you must forthwith.
comply wi8n 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, CW Code.) ,
Lenders 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.
certify that I have read this application and state that the above information is correct.'
1 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 Date
Mailing Address
City, State, Zip
No. 05245
BUILDING:. TYPE CONST. OCC: GRP.
A.P. Number 617-640-006
Legal Description 111A2..,
Project Description Plan 3A. Lot 6
't
Sq. Ft. No. No. Dw.
.Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
?ringer -Toed L
TOTAL
AMOUNT
` �" ivy` ,i FJ�}. �•
49..3,
..39.0 ar6q//
8•. V
" 8 .0
7 .._ 1
2,399.0
za91rd T3 - u
� • a .
$3,.468-.1..�1;:.
REMARKS
>Fsi:i 5. 1 !�•4! Y � ��h: i�F.' f: i'•*,'_ �i � w "'Y di .� fi' . .a � i � T^'
• .a. S+' 4t=e: a +.. � �/v?tz,.. a •� +y+ r a .�
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
12/34/68
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
B GRADE 2��
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
LIWZ RMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SQ FT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING S �Q
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
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
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
MESH
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINISH GRADING
SQ.FT.GAR ® 3/ic
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
ROUND PLUMBIN�%�
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE 2��
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
LIWZ RMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
�y
FINAL INSP. K
FRAMING S �Q
FINAL INSP.
�, /1 D
ROOFING GG VP
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING!/
MESH
r
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
t