002259 (SATT)44a
P.O. BOX 1504 No. 002259
Building 78-105 CALLE ESTADO
Address 80-46A P@.e rAxach LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 05 COMAXfl Milb .gym A.P. Number
City Zip Tel.
palm 92260 568--282$ Legal Description
Contractor Project Description PM v'i'i' 11my 30 0
Address Maw a 8
City Zip Tel-
�,i3il>t3
State Lic. City =.G' 2325
& Classif.$8 Lic. # Sq. Ft.s6a No. No. Dw.
Arch:, Engr.; 3218Size Stories Units '•
Designer New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S. DECLARATION
hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect..
SIGNATURE f'-u:r C
DATE
r OWNER -BUILDER DECLARATION ti EStlrriated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following`p$''3���
reason:" (Sec. 7031.5, Business and Professions Code: Any city or. county which requires - a '
00
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 •PERMIT - AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Oivision'3 or 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). y
❑ I, as owner of_the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. s
do the work, and the structure is not intended or offered -for sale. (Sec. 7044, Buisness and Const. Professions Code: The Contractor's License Law does not apply*to an owner of property .who •
50
builds or improves thereon and who does such work himself or through his own employees, MechCCCe �4
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 '
of proving that he did not build or Improve for the purpose of sale.) lJ .a
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct.Ahe project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts for S•M.I.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑. I am exempt under Sec.. B. & P.C. for this reason
Driveway Enc. i
Date owner Infrastructure 2..000.00
WORKERS' COMPENSATION DECLARATION
I hereby'afffrm 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 tho 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., If, after making this Certificate of Exemption you should become
subject to the Workers'- Compensation provisions or '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 - r ' Date /r .' �•
Mailing Address ` or
City, State, Zip
r,
HARD COPY
TOTAL Q°a7
REMARKS
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 4-8-86 Permit
Validated by:
Validation:
A5109
4 8 6485,17 Cf,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. 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
1 r
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
6
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
LUMBER GR,
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LeRAMING
06*49AL INSP.
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
A SLAB GRADE 6i L/
1 r
�(�ROUGH PLUMB. �� 0 42
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR S?ZIP)A
ROUGH WIRING $ p
DUCT WORK
ROCK STORAGE
/ny FOUND. REINF. S^�
fpt,e
6
�/t�GAS (ROUGH) F
U
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR,
CA INAL INSP. J(,041 j6L
LeRAMING
06*49AL INSP.
Q LdROOFING �i�U
F�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
( WLATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
IV K W %ANA 1 V MCJ/11711 IALb.
GARDEN WALL FINAL
De -1 Lv alL rlA6