2934 (SIGN)P.O. BOX 1504
Building 78.105 CALLE ESTADO
Address Colmar U ��� r LA QUINTA, CALIFORNIA 92253
Owner .F
Mailing
Address
City
Contractor
No. 002934
BUILDING: TYPE CONST. OCC.-GRP.
101 AD N b ��.?—?': w�ai' 2: 769-030 -032 wyc;
• • • aM um er_
Zip ITel. —,uws A 1
Legal Description
Project Description
Address
City Zip
Tel.
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New IKI Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby afflrfn that I am exempt from the Contractor's License Law for the following
reason: (Sac. 7031.5.%uirrsss and Professions Code: Any city or county which requires a
permit to construct, after. Improve, demolish, or repair any stmctura, prior to its Issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Confraclor's License Law, Chapter 9 (commencing with Section 7000) of
Estimated Valuation
+ 3 90 . Gr
t'
PERMIT
AMOUNT
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 penalty of not more than'Rve hundred dollars ($500).
❑ 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, Bufsness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
Plan Chk. Dep,
Plan Chk. Bal.
Const.
nA@Cil
buNds or Improves thereon and who does such work himself or thmugh his own empfoyees,
prevfded that such imprvvaments are not intended or offered for sale. If, however, the building
Electrical
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
❑ 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
S.M•j,
Grading
Driveway Enc.
Date Owner
Infrastructure
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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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
employ any person in any manner so as to'become subject to the Workers' Compensation
Laws of Cali crnia.
DateOwner
NOTICE TO APPLICANT., If, .after 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-
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.
FINAL DATE
INSPECTOR
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 ordlnancf:s and state laws relating to building
Conslmction, and hereby authorize representatives Hof this city to enter the above•
mentioned property for inspection purposes.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
A 7 3 4 2
Z 18 20,0G U
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBIN , 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
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOl1NTAIN
URINAL
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/nc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE JONST.
FEE
ELECT. FE l
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.IEQUIP.
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
t
I
D4E
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
,YW•.. oF
PA R C E L . 5
1
Ur 1•: 1 /a t)r N"11 /
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ALL IN rr:r:TI(W S. _t
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er. I'a�.
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SECTION • 6
FEW W Not a WRVZT OF TIIC LANU BUT 11 COM}ILRD IOU
iNMRM&T7DM ONLY FROM DATA MHO N YT ORIICILL RiWRI16
EXCLUSIVE AUTHORIZATION AND RIGHT TO SELL
THIS IS INTENDED TO BE A LEGALLY BINDING AGREEMENT —READ IT CAREFULLY,
CALIFORNIA ASSOCIATION OF REALTORS1- STANDARD FORM
1. Right to Sell. I hereby employ and grant —CoAC-RiELL09 WALLiEy.E AL2 X
hereinafter call d "Agent;' the exclusive and irrevocable right commencing on JAN - i S ,19 9 7 , and expiring at
midnight on H pQ I i i 5 19A '7—, to sell or exchange the real property situated in —LA Qui N T 4 _,
County of , California described as follows:
eqRS=CL If•4 c :&- /
ASSEScraS faac-et- 1$.490-AC42ES —SEE ATTACHED 64.AI0:92
0[2S PAJZC.E L ►q0 IEP - -JAeq-09J0- 001 J1J. SS0 AC-4—ES- SEE ATtAGt-tEp 04A4 003
otz5 _PAR-CCL fAtJ t-9•_ACRES - SEE ATTACf-PCs] 04A1002
2. Terms of Sale. The purchase price shall be $ , to be paid in the following terms:
C-A 5H At C LOSt a_F _rFSC-{Z0t.[.1
(a) The following items of personal property are to be included in the above -stated price:
uVIV n1UNl?V' i cUt u:-i; l:ri �;,_�'
(b) Agent is hereby authorized to accept and hold on my behalf a deposit upon :he purchase price.
(c) Evidence of title to the property shall be in the form of a California Land Title Association Standard Coverage Policy of Title Insurance in
the amount of the selling price to be paid for by LLE 2
(d) I warrant that I am the owner of the property or have the authority to execute this agreement. I hereby authorize a FOR SALE sign to be
placed an my property by Agent. I authorize the Agent named herein to cooperate with sub -agents.
3. Notice: The amount or rate of real estate commissions is not fixed by law. They are set by each broker individu-
ally and may be negotiable between the seller and broker.
CompensatioV
Agent. I hereby agree to compensate Agent as follows:
(a) % of the selling price if the property is sold during the term hereof, or anyextension thereof, by Agent,
on the terms herein set forth or any other price and terms I may accept, or through any other person, or by me, or %
of the price shown in 2, if said property is withdrawn from sale, transferred, conveyed, leased without the consentof Agent, or made unmarket-
able by any voluntary act during the term hereof or any extension thereof.
(b) the compensation provided for in subparagraph (a) above itprope rty is sold, conveyed or otherwise transferred within 6f'.5
days after the termination of this authority or any extension thereof to anyone with whom Agent has had negotiations prior to
final termination, provided I have received notice in writing, including the names of the prospective purchasers, before or upon termination of
this agreement or any extension hereof. However, I shall not be obligated to pay the compensation provided for in subparagraph (a) if a valid
listing agreement is entered into during the term of said protection period with another licensed real estate broker and a sale, lease or
exchange of the property is made during the term of said valid listing agreement.
4. If action be instituted to enforce this agreement, the prevailing party shall receive reasonable attorneys fees and costs as fixed by the
Court.
5. In the event of an exchange, permission is hereby given Agent to represent all parties and collect compensation or commissions from
them, provided there is full disclosure to all principals of such agency. Agent is authorized to divide with other agents such compensation or
commissions in any manner acceptable to them. v
6. 1 agree to save and hold Agent harmless from all claims, disputes, litigation, and/or judgments arising from any incorrect information
supplied by me, or from any material fact known by me concerning the property which I fail to disclose.
7. This property is offered in compliance with state and federal anti -discrimination laws.
8. Other provisions:
9. 1 acknowledge that I have read and understand this Agreement, and that I have received a copy hereof.
Dated ,19 , California
Ce yAh"ll:f
OWNER
Address
City, State, Phone
10. In ❑nsideration of the bove, Agentt agrees to use diligence in procuring a purchaser.
Agent �Ey �C EAG,z Y Address, City.}d- &X /QI
By Phone, Date fo�9 S61�6f f
NO REPRESENTATION IS MADE AS TO THE LEM VALIDITY OF ANY PROVISION OR THE ADEOUACY OF ANY PROVISION IN ANY SPECIFIC TRANSACTION.
IF YOU DESIRE LEGAL ADVICE, CONSULT YOUR ATTORNEY.
To order, contact —California Association of Realtors`
525 South Virgil Avenue, Los Angeles, California 90020
Copyright c 1978 by California Association of Realtors` 12r
(Reviewed 1984) FORM A-11
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