05938 (SFD)P.O. BOX 1504 N o . -0593.8,
Building X78-695 Vita 78105 CALLE ESTADO .:
Address -'LA QUINTA; CALIFORNIA 92253, .. .
Owner
Mailing t3ict=arty. - . + BUILDING: TYPE CONST. -OCC: GRP. '
Address 68 -713 -Perez did. i :4
A.P.'Number
City Zip Tel. K r,
C.�t c;r 92234 7739024 Legal Description O 11 Lot 16
Contractor. `"' , •. Project Description • FIMM 1620 -Pure La ftintE µ
8att£' ...
Address
City Zip Tel.: ;
State Lic.-' 337077 City %ai9 •i:�' '
8� Classif. Lic. # Sq ,Ft.2 ► No. No. DW.
` Size 'Stories Units. -
•' ''Arch., Engr.; •' - -
r Designer : ; . - New.M Add ❑'
Address" Tel.
City sti• T Zip State"
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisiiool) 3 of the Business and Professions Code, and my license is in full force and +
' effect
SIGNATURE DATE .
z r OWNER -BUILDER DECLARATION
�' - Estimated Valuation I G. X22 i0
I hereby'-afftrin that I am exempt from the Contractor's License Law for the following • # •
Alter ❑
Repair ❑ :Demolition ❑ '
r ,fit -
/
F . »`reason: (Sec. 7031.5,8usreass and Professions Code: Any city or county which requires a
;.Qemdl ro carmstruct. aQ: •improve, do nfdt, or repair any structure, prior to its issuance also
requires the applicant fm such permit to file a signed statement that he is licensed pursuant to
• - the provisions of the Canbactor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the gess and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption- . A" ,violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a rrvd penalty of ref more than rive 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, Buisness and
_Professions Code: The Conbactors License taw 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 inerovement is sold within one year of completion, the owner -builder will.have -the burden
of proving that he did not build or krprove for the purpose of sale.) ,
'
PERMIT' -' 14
Plan Chk. Dep.
-,
Plan Chk: Bal.',
Const.
Mech. -
Electrical '
Plumbing.
❑ 1, as owner of the properly, am exclusively contracting with licensed contractors to con-
' struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
S.M.I. -
does not apply to an owner of property who builds or improves thereon, and who contracts for
'such projects with a convactWs) ftensecipursuent to the Contractor's License Law.),
❑ 1 am exempt under Sec` B_ & P.C. for this reason
Grading "
Driveway Eric...
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
1 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 y
V119 Copy is filed with the city_ ❑ Certified copy is hereby furnished.
- + 1, ,1
TOTAL
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
4 employ any person in arty manner so as to become subject to the Workers' Compensation
Laws of Catifomia -
Dat
AMOUNT
572.00 � '
66..50
199.80
1200,50
5.95' .
1908.50:
.Aha -Ie. oaA �. .. � • t•,' l�
REMARKS a: '.c•Ttra`sA�'Ri,+?E1•riSaX rcrt istS6t
.r .Kyx.., gri�tetsr•' .r..• -�-r ry - • - •. ,
e Owner _ _
NOTICE TO APPLICANT: d after malft , this Certificate of Exemption you should become ZONE: BY: '
subject to the Mbdms' -Compensator provisions of the Labor Code, you must forthwith
comply -wilt; such provisions or ids permit shallbe 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, aril code.) Side Setback from Property Line
Lenders Name
Lenders Address
'd - This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE '' INSPECTOR
expiration if work thereunder is suspended for 180 days. r 6-16-89
r
1 certify that have read this application and state that the above information is correct. Issued by: Date' Permit
` I agree to comply with all city arid 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 IValidated by: ^ '
Signature of applicant Date'
.'Mailing Address -Validation:
City,. state, Zip c y
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
F
2ND FL Sp. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
AS (ROUGH) _
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WATER HEATER
WALL Sp. FT.
FINAL INSP.
DRINKING FOUNTAIN.
Sp FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING
FLOOR DRAIN
MECHANICAL FEES
i
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ZONE ROOFING:
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE tL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
1�4,-�-e,�iri'
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
OC
FOUND. REINF. `
AS (ROUGH) _
METER LOOP
HEATING (FINAL)
OTHER APPJEQU1P.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
�
I AL INSP. SGL
FRAMING
PENAL INSP.
q
074e -4
ROOFING 4 /;g,/
i
///,/
j/J ���(2�/"/-i��1FIRE
PAT
REMARKS:
VENTILATION
ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING�n`��
MESH
INSULATION/SOUND zkkA
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL