002230 (SATT)* 4 . 44.. 0
hf Qgk&.-
P.O. BOX 1504
Building 80-388�
Address LA QUINTA, CALIFORNIA 92253
Mailing
Address*7 CA 4fflm _S"h � _
City Zip - Tel.
Det 922£0 .55,68-4828
Contractor
watl aqe and Land
Address
No.. 002230
11LDING: TYPE CONST: OCC: GRP.,
P. Number
!gal Description
oject Description PIA TOM MAN 40 0
4Q 7 D
NOTICE TO APPLICANT: If, alter 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 inspectionCCp�urposes.
Yr _ !i✓��li J ,
Signature of applicant t _ Date f .�
Mailing Address
City, State, Zip (' /
HARD COPY 1
ZONE:
BY:
Minimum Setback Distances:
City
a
Zip
Tel.
Rear Setback from Rear Prop. Line
State Lic.
& Classif. 288130
City
Lic. # 32$
UC 3142
Sq. Ft. M 5$9
Size
No. 1 No. Dw.
Stories - Units
Arch., Engr.,
Designer
New Ik Add ❑
Alter ❑. Repair ❑ Demolition ❑
Address
Tel.
4
City
Zip
State
Lic. #
4 8 3580.17 CK
- • LICENSED CONTRACTOR'S DECLARA.IfON .
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 130) of Division 3 of the Business and Professions Code, and my license is infullforce and
effect. y
SIGNATURE it + + ✓ a+_ a 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• after, 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 byeny applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). '
01 , 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 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 for sale. If, however, the, building
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.) , . .
❑ 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) licensed pursuant to the Contractor's License Law.)
0 I am exempt. under Sec. B. & P.C. for this reason
Estimated Valuation
�y {�/�
d.�l�F.i's9�Li1i
I 49 Wi
IW
PERMIT-•
-' AMOUNT
- •
PIan.Chk. Dep.
-
-
Plan Chk. Bal.
419
CO11St.'
fa„
678.00
Mech. .
�i'"�..ifi
_
'.Electrical
�y (y C
- 1wCCDs 7
128.65
Plumbing
A ^
140.5!
S.M.I.
�y
33&83:
Grading
Driveway Enc.
Date Owner
Infrastructure
h
2,000.00
WORKERS' COMPENSATION DECLARATION
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 if 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' "
TOTAL
..
r�
REMARKS
'
NOTICE TO APPLICANT: If, alter 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 inspectionCCp�urposes.
Yr _ !i✓��li J ,
Signature of applicant t _ Date f .�
Mailing Address
City, State, Zip (' /
HARD COPY 1
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 4"'7'°'86 Permit
Validated by:
Validation:
A5111
4 8 3580.17 CK
CONSTRUCTION ESTIMATE AdlkkNO.
ELECTRICAL Fr-gdlkk
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
I
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 HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
AS (ROUGH) jn
:C
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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
f4obROUND PLUMBING �
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
&ZOUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
f,,JSEWER OR SdT5PTA K
CROUGH WIRINCa01 Q �/
( to
DUCT WORK
ROCK STORAGE
FOUND. REINF.
O GC
AS (ROUGH) jn
:C
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.
Z(_eF AMING OI O �/n
(,�INAL INSP//
PKEIOOFING O%CSG �.
rr VENTILATION
-
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
FIREWALL
//GAR.
LI(Ck:ATHING �Lr
MESH
INSULATION/SOUND /
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
Ott
INSPEU OX'S SIGNAI URE511NITIALS.