002388 (BLCK)44
P.O. BOX 1504 N 0, 002388
Building 78-105 CALLE ESTADO
Address 13 -7", Vista G'armb LA QUINTA, CALIFORNIA 92253
Owner .._ . ...... .. .... .... ._ _.
Mailing
BUILDING:. TYPE CONST: OCC..GRP..
Address A.P. Number
Zip Tel. • "
% #1
3.47-4419 Legal Description
City
Contractor Project Description
/b5
Address
City. lZip. .. Tel.' .
State Lic. City
& Classif. . Lic. # Sq. Ft. No. No. Dw.
• Size Stories Units
Arch:, Engr:,
Designer " New ❑K Add ❑ Alter ❑ Repair ❑.' ' Demolition ❑
Address Tel. 90 lin. 5eet of Hoo high b
City Zip State 90 M. feat O 3ftnt hidh rod i><1c3z1
- 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. . .
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
Ihereby affirm that I am 'exempt from the'Coniractor's License Law for the following . tA�•«C
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 PERMIT - -AMOUNT
the provisionsaof the: Contractor's License Law, Chapter 9 (commencing with Section .7000) of.
Division 3 of the Business and Professions Code, or'tffat.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' Deli..
'subjects the applicant to a -civil penalty of not more than five hundreddollars($500).'-
. ❑ 1, as ownerof the property, or my employees with wages as their sole'compensation, will Plan Chk. Bal... 32.
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. Const..�.�
builds' or improves thereon and who does such work himself or through" his own employees, ' Mech.
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 EIBCtrICdl
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- Plumbing
strucL•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 S•M.1.
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
/:�., o7 Driveway Enc.
Date Owner ".! AVT� 'A� �� .� Infrastructure
WORKERS' COMPENSATION DECLARATION
L.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 thecity. Q Certified copy is hereby furnished. . _ ..
TOTAL R3.92
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE. .
(This section need not be completed if the permit is for one hundred'dollars ($100) valuation
or less:) ..
certify that in the performance of the work for which this permit is issued, I shall not
• employ any person in any manner sous to become subject to the Workers' Compensation
Laws of California.
Date'—L–" •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
l,'hereby affirm that there is a construction lending agency.for.the performance of the
.work for which this permit is issued.. (Sec. 309 7,Civil Code;)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signedand•validated, andis subject to
expiration it 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 represeritatives of -this city to :enter the above-:
mentioned property for inspection purypo_.ss. f
Signature of applicant �� �� �. V./'r'6 - ;.lS ^.. Date
Mailing Address
City, State, Zip
i
HARD COPYI
ZONE:
BY:
Minimum Setback'Distances:
Front.Se.tback 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:
Elate � � Permit
Validated by:
Validation:
A5688
5 29 83,82 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT. ®'
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ. FT. p
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
/l
b�i/8E9
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
i�
SO.FT.GAR ® 3/ec
HOUSE SEWER
REMARKS:
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
GROUND PLUMBING
UNDERGROUND
A.C'UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
/l
b�i/8E9
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
i REINF. STEEL d // d
GAS (FINAL)
TEMP. POLE
GROUT/
WATER HEATER
SERVICE
FINAL INSP.
/
BOND BEAM 4; 71eW
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
i�
a
DEC 190
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL