04982 (SFD)4
P.O. BOX 1504 No. 04982
Building 78-105 CALLE ESTADO
Address 54"368 Inverness 'LA QUINTA, CALIFORNIA 922_53
Owner
Mailing Suari8e Company BUILDING:' TYPE CONST. OCC: GRP.
Address
42-6f)(1 roink s aotr yr •� 241A A.P. Number PCM %Wn�+ta 'Pvnet 17AII-1
City Zip Tel. -
?A114� Legal Description
Contractor`
Project Description 2%I*+�^ ',�� . p1 p,,,. SflTniTl!
Address
City "' Zip Tela
State Lic. City
& Classif. 288130 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
Cityip I State
IZ
1 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of bnnsion 3.01 the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE ' + DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Buseness and Professions Code: Any city or county which requires a
permit to constmct, after, improve, demofsh, or repair any structure, prior to its issuance also
requires the applicant for such permit to lila 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
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a ani penally of riot 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, Buisness and
Professions Code: The Contractors 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
orimprovement is sokf within one year of completion, the owner -builder will have the burden
of proving that he did not build or inprove 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 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) ficensed pursuant to the Contractor's License Law.)
❑ 1 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
Worker's 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' COMPENSATION INSURANCE
(This section need not be completed ff 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
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: h, 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 the pemuT shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 certity 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.
Signature of applicant Date
Mailing Address
City, state, zip
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft. 2596
Size., A o
57
New 0 — Add ❑
No.
Stories
Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
Side Setback from Property Line
FINAL DATE
INSPECTOR
12/8/88
Issued by:
Date Permit
Validated by:
Validation:
Estimated Valuation
$179.818
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Q 525.10
Const.,
633,00
Mech.
Is 5 r
Electrical
k
)
Plumbing
132.5.1
S.M.I.
Grading
Driveway Enc.
Infrastructure
IkA.045.90
2.022.95
.Adtfa a
TOTAL
REMARKS
_0
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
12/8/88
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2
UNITS
SLAB GRADE
2ND FL SO. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. SQ. FT. ®
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN
99ERVICE b
FINAL INSP.
URINAL
SOFT®
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
ING 41FINAL
`
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOHDISH)
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
INSULATIONISOUND
SO.FT.GAR ® 3/ic
HOUSE SEWER
F SH GRADING
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
FORMS
S ER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS(ROU
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
A INAL) 7
TEMP. POLE
GROUT
WATER HEATER
99ERVICE b
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
ING 41FINAL
`
INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
HING
MESH
INSULATIONISOUND
F SH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL