002195 (SATT)4
P.O. BOX 1504 NO. 002195
Building 78-105 CALLE ESTADO
Address flo-429 rahble Baaab LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address 75—MIS Ontratry ChAh sive A,P•Numb_e_r
City Zip Tel.
PWM 56 - 28 Legal Description
ContractorProject Description VM Sir � 2 $
Address... PIM 20 0
City Zip Tel.
a
State Lic. City r= 2596
& Classif. 280130 Lic. # 328 Sq. Ft. GM '57i No. No. Dw.
Arch., Engr.; " Size -Stories Units
Designer New Di Add ❑ Alter ❑-' Repair ❑ Demolition ❑
Address
Tel.
Minimum Setback Distances:
Front. Setback from Center Line
Rear Setback from Rear Prop. Line
City
Zip
State
. . .
FINAL DATE
Lic. #
Issued by:
Date 3.48 86Permit
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section '
70 00) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. . \7
3 18 3394,95-Cti
SIGNATURE .+' - DATE
6WNER•BUILDER DECLARATION
Estimated Valuation
I hereby affirm that 1 am exempt from the Contractor's License Law for the following�
•7031.5,Business Code: Any
♦CyyS
710. 00
reason: (Sec. and Professions city or. county which requires'a
M- permit to .construct, after, improve, demolish, or repair any structure, prior to its issuance also
i6
requires the•applicant for such permit to'file a signed statement that -he is licensed' pursuant to
PERMIT
+^ AMOUNT
the provisll ns 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
- -
Plan -Chk. Dep..
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bdl.
p
4.95x.15
❑ 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
Const:,�rr�V
p
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,
Mech.
�55.00.��
provided that such improvements are not. intended or offered for sale. If, however, the building
.
or improvement is sold within on e year of completion, the owner -builder will have the burden
Electrical -
i
of proving that he did not build or improve for the purpose. or sale.) ..
..06
D 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
U2.50
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
S.M.I.
11.'24
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
-
Grading
O I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc
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 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
NOTICE TO APPLICANT., It, after making this Certificate of Exemption you should become _
subjectto 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. ,
Y -
Signature of applicant t _ Date �� t
Mailing Address Pv
City, State, Zip
HARD COPY
Infrastructure 2,000.00
TOTAL 3.394.95
REMARKS
PrInT. PM 9M WY`EI" PAM nP rA 1i q
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 3.48 86Permit
Validated by:
Validation: -
A43.3i.
3 18 3394,95-Cti
CONSTRUCTION ESTIMATE All
NO. ELECTRICAL FFr
NO.. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. Ff. ®
GAR. SQ. FT. ®
CAR P. Q. FT.
WALL SO. FT. ®
SQ 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 HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT F!E:l
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMIPLUMB. 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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
IM JYLt:I VM"J 01UNA 1 UMrWINI I IALJ
GARDEN WALL FINAL