003793 (SATT)T -A
P.O. BOX 1504
Buildin78-105 CALLE ESTADO
Address 56-000 Pebble -Be4ch _ � _ . LA,QUINTA,,,CALIFOR, NIA 92253„
Owner
Mailing
Address
City q
Contractor
.Address
��ttfaai€€
State Lic. 28813 i
& Classif: .
Arch., Engr., Designer-
Address
esigner-Address
Zip Tel.
1Y M+
Zip
BUILDING: TYPE CONST. OCC: GRP.,
A.P. Number PGA 1.1fa t _-
Legal Description
Project Description PTAT% '113M
Tel:
City
Lic. #, _ . 32 Sq. Ft. .D O. 282. No. .... .. :.
Size $ Stories
New Fl. Add Fl,. ' ' Alter R
No:•Dw. -
Units
Repair ❑ Demolition ❑
City
Zip
State
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.. ti r r `�•� . i ri`_f f
-' - _ -
_-- '__ •'
SIGNATURE - DATE
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) 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 civil penaltyof not 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, andthe 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
Estimated Valuation - - -
•' 44 _'642 '
-- - '
n •' PERMIT - - - - AMOUNT '
- _
,z Plan Chk. Dep. • - -
- -.
PIan.Chk.. Bal.. .. 55, .10
.qgy rte0
•' Co,n St: _ d 0 .
• - - .� ^ '
McCh.' m it
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. ll, however, the building , '
' .Electrical. - - ' ' -' 'x
•
or improvement is sold within one year of completion,- the owner•builder. will have the burden
of proving that he did not build or improve for the purpose of sale.) „ - ', •
Plumbing 116 .50
0, 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
..
S.M.I.• �" .62
.
Grading
Driveway Enc.
Date` owner
Infrastructure 4.380 X57
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.
TOTAL '_ 933 An
REMARKS'
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 thispermit is issued, I shall not
•employ any peon in any manner -so as to become subject to the Workers' Compensation
Laws of Cal ifornirsa.
i e•➢ i.,,' _-. ��,3. a i.°
' 'Date Owner
.
NOTICE TO APPLICANT: g, after making this Certificate of Exemptiori 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..
..ZONE: • !BY: '
Minimum Setback Distances: - - -
Front Setback from. Center Line
'
Rear Setback from Rear Prop. 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.)' .. -
Side Street Setback from Center. Line,
-
Side Setback from Property Line
Lender's Name
Lender's Address
. FINAL.DATE-• - .INSPECTOR ,
4/6/88-_.
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. c
I certify that I have read this application and state that. the above informationis correct.
agtee 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.
,Issued by- Date Permit
Validated by:
Signature of applicant - Date
Mailing Address
Validation: -
City, State, Zip
-
„ HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SO, FT. @
CARP. SQ. 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.COOL HO00
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
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.
SQ. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4c
HOUSE SEWER
REMARKS:
VENTILATION
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 APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL