002236 (SFD)P.O. BOX 1504 No. 002236
Building 78-105 CALLE ESTADO
Address 54-976 Inversass LA QUINTA, CALIFORNIA 92253
Mailing
Address 75-005 0= -A=y Club Dry
City lZipTel.
..- palm 13 ... ,2,. -%8-28'28.
Contractor
ress .
City IZip
- BiSEt�
State Lic.
& Classif. 288130
Arch., Engr., -
Designer'
Address'
City
Lic. # 328
Tel.
11LDING:- TYPE CONST. OCC: GRP
P. Number
Igal Description
WEW
oject Description TIM� 2a Q
PhaWl $
Sq. Ft. I= 2596 No. No. Dw.
Size MR 577 Stories 1 Units I
New Ek Add O Alter O Repair O Demolition ❑
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: J
Signature of applicant K fi r` �%+�% //r Date f ., r
Mailing Address S• !1 ��'4 "� tr
City, State, Zip
9
HARD COPY
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 4-7-86 Permit
Validated by:
Validation:
A"5081 4 8 3394,9.5 U
City
Zip
State
. . .
Lic. #
LICENSED CONTRACTOR'S DECLARATION
.,
I hereb, affirm that I a,m 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.-
SIGNATDRE S". y'� = ♦ ..r v... r •- DATE
.
`DWNER•BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following�+i�+y.�.
Estimated Valuation
reason 7031.5 7031.5, Business and Professions Code: Any city or county which requires a
r7 Jw
oermit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
-
requires the applicant for such permit,to file a signed statementthathe is licensed pursuant to
PERMIT - AMOUNT
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 Any Section 7031.5 'any for
-
Dep. -
alleged exemption. violation of by applicant. a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
,Plan.CW
Plan Chk. Bal. 495-15
O 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. (Sea 7044, Buisness and
Const. 588.00
Professions Code: The Contractor's License Law does not apply to an owner of property who.
builds or improvesthereon and who does such work himself or through his own employees,
Mech(%
ro
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
Electrical' g��3.06
of proving that he did not build or Improve for the purpose of sale.) -.
, .ia
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing 132.50
strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
A
does not apply to an owner of property who builds or improves. thereon, and who contracts for
S.M.I. -- 4
•
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) • -
' Grading
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure 2,000.00
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.
TOTAL.
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.)
I certify that in the performance of the work for which this permit is issued, I shall not
r
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date `"" Owner
NOTICE TO APPLICANT: If after making this Certificate of Exemption you should become
- ZONE: BY: '
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
.MlrtlfnUm Setback Distances:
Front Setback from Center Line
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: J
Signature of applicant K fi r` �%+�% //r Date f ., r
Mailing Address S• !1 ��'4 "� tr
City, State, Zip
9
HARD COPY
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 4-7-86 Permit
Validated by:
Validation:
A"5081 4 8 3394,9.5 U