003289 (ELEC)Building 5i'-W4h UWME$S
Address
Owner
� QUW
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 75-005 COMMY CLUB DIMS
City Zip Tel.
I,AM DESEM 42280 - 568-2828
Contractor NMT/tM wND ' TG M
Address ..
No.. 003289
BUILDING: TYPE CONST. OCC: GRP. '
A.P. Number PGA IMSl
Legal Description PHS$ 26 A
Project Description 140 CSN A• �'
rsR'�i$
City
Zip
Tel_
State Lic.
& Classif.
City
Lic. # 328
Sq. Ft.
Size -
No. No. Dw.
Stories Units
- Arch.; Engr:; ' • - - -
Designer.
New ❑ Add ❑
Alter 0 Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
- ,LICENSED CONTRACTOR'S DECLARATION.
I hereb affirm that I am licensed under provisions of Cha ter9 (commencing-
y p ( gull f Section
7000) of Divisionf3 of the Business and Professions Code, and my license is infullforce and
effect. /ACJ! .-$1 1., _< � - - ' 7 / , -) sI
g
SIGNATURE> w•' Y —A W iv'.e.:^P a+DATE
3` f OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000)or
' Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. *Any violation o/ Section 7031.5 by 'any applicant. for a permit
subjects the applicant to a civil penalty o/ not 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
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 /or sale: 1/, however; the building
or improvement is sold within one year o/ completion, the owner -builder will have the burden
of proving that he did not build or improve for. the purpose ofsale,.) . ,
O 1, 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) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. -B. 8 P.C. for this reason
Estimated Valuation
--
PERMIT'
-
- AMOUNT
Plan, Chk. Dep..
'
-
Plan Chk. Bal.
Const.
Mech.
Electrical
- �� -
+
Plumbing
S.M:I.
Grading
Driveway Enc.
Date owner
Infrastructure
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. 0 Certified copy is hereby furnished.
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 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 Calif0 nia.
.+ s
,
TOTAL
2.2.50
REMARKS
-
- r•._ r. ♦'r.•i a, A 441%13
(i %fi;�Yi I {19 ter ._. .
a 6—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
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.)
Lender's 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.
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 representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
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
Issued by: Date 7/97/A7 Permit .
T
Validated by
Validation:
CONSTRUCTION ESTIMATE
NO.' ELECTRICAL FEES.
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT. ®.
POR. SO. FT. ®
GAR. SO, FT. ®
CARP. SO. FT.
WALL SO. FT. ®
SO FT ®
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
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER G.R.
FINAL INSP. / Z/
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
- FENCE FINAL
N5FLUI UN'J WUNA 1 UKLblINI I IAUk
GARDEN WALL FINAL