06782 (RPL)4
P.O. BOX 1504 No. 06782
Building78-105 CALLE ESTADO
Address 9-0„^15 Horseshoe 'WD - LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Peack BUILDING: TYPE CONST. OCC: GRP.
Address Sam A.P. Number 617-112-025
City Zip Tel.
Ls. Quia;ta 92253 Legal Description
Contractor
Project Description Pool �A. boa
P 6r. P P001ft
Address
RA—Q71; R w ^
Cit .. .
y Indio Zip 92201 Tela 34 _ 5 . 7507fl _
State Lic. City _
& Classif. 53475807 Lic. # Sq. Ft. No. No. Dw.
Arch., Engr.,
Size ' ' Stories Units
-
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirrn,that-1 am licensed under proyisions of Chapter 9 (commencing with -Section
7(100)'of Division 3 of the Business and Profe�sssii�ons,Code, and my license is in full-force=and
effect .�r.,...•w-�^".nr��.''"'�"`✓"�.r�'�ic`"'.�,.•' /j�,1 �
SIGNATURE"DA
"OWNEWBUILDER DECLARATION Estimated Valuation'
I hereby affirm that 1 am exempt from the Contractor's License Law for the following 1 f Ian
reason: (Sec. 7031.5, s and Professions Code: Any city or county which requires a 110€ 0
permit to construct. after, r prove, demolish, or repair any structure, prior to its issuance also
requires the app6pnt for such Pernik to We a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractors 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 exenptbn- Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a circ penally of not more than Five hundred dollars ($500).
❑ 1, asowner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 81.90
do the wodS and the structure is not intended or offered for sale. (Sec. 7044, BuisnessanConst. d 1 �fC /�
Professions Code: The Contractors License Law does not apply to an owner of property who 126.00
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 Mech. 24.00
or improvements sold within one year of completion, the owner -builder will have the burden Electrical �1
30
of proving that he did not braid or improve for the purpose of sale.) 30.00
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con, Plumbing 27.00
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not appy to an owner of property who builds or improves thereon, and who contracts for S.M.I. X77
such projects with a.contrador(s) icansed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec_ B. & P.C. for this reason
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
Workers 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.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE r �1
'(This section need not be completed 9 the permit is for one hundred dollars ($100) vahration _ � $ - ,vf ,n 1 � i ';i •' tj,,,,,,, „ �
'or less.) .L iJ t,,�a✓1T .a ::s tri.- .. ..,
I certify that in the perfomrence 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 California
Date Owner
NOTICE TO APPLICANT: 9, after making this Certificate of Exemption you should become ZONE: BY:
subject to the workers' Compensation provisions of the Labor Code, you must forthwith
Comply With such Provbb sor9rsPermitshallbedeemedrevoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, CIO code.) Side Setback from Property Line
Lenders Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days. 1/2/90
1 certity that I have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant Date -
• - Mailing Address Validation:
City,. State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FESS
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL SQ. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CARP. SQ. FT.
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IKITCHEN 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 ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
INSULATIONISOUND
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)rLt�I "I(JV'If
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
y plus xS
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
rf^�
/nI)
✓L �`y�
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
l