002848 (BLCK)axiom.
P.O. BOX 1504 No. 002848
Building 78-105 CALLE ESTADO
Address 77-13A AVII Pftmando LA QUINTA, CALIFORNIA 92253
Owner
is tuaxta Joh ventum
Mailing'
Address P.O.
City Zip Tel.
La ��ta 92253 . 564--1.315-
Contractor
Address .
City Zip Tel. _ -
Palm � 92260 563-0078
State Lic. City
& Classif. 236088 Lic. #
Arch., Engr., -
Designer
Address Tel.
City Zip State
. _. Lic. #
LICENSED CONTRACTOR'S DECLARATION
i 1 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
I effect.
SIGNATURE 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
I 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
the provisions of the Contractor's License Law, Chapter 9 (commencing with.Section 7000) of
i-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 five hundred dollars ($500):
❑ 1, 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
I 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.) '
' O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
slrucl the project..(Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improvesthereon, and who contracts for
i such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
j ❑ 1 am exempt under Sec. B. & P.C. for this reason
i
Date '� P"!t !,Owner %/`%'—y f
WORKERS' COMPENSATION DECLARATION
+' I hereby affirm that I have a certificate of consent Ao self -insure, or a certificate of
i Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. - Company
0 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 the work for which this permit is issued, I shall not
I •— •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 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.)
Lenders 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant 4 Date r' (-
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. OCC: GRP.
,A.P..Number
,Legal Description
Project Description Pe t to inst2 mitcmat4c
ciaW Wild fmce for 't=t 213.20
BY:
Minimum Setback Distances:.
Front Setback from Center Line
Sq. Ft. 150 1jM f#- No-
Size ?Stories
No. Dw.
Units
New a Add ❑ Alter ❑ Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 1--21-87 Permit
Validated by:
Estimated Valuation
20,060.00
Validation:
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.'
91.32
Const.
140.50
Mech.
Electrical
Plumbing
S.M.I.
137 '
Grading
Driveway Enc.
Infrastructure
TOTAL
233.19
REMARKS
HARD COPY1.
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 1--21-87 Permit
Validated by:
Validation:
A7168
1 6 33.19 U
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING F?fv
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WIRING
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. Q. FT. ®
HEATING (FINAL)
WALL SQ. FT.
REINF. STEEL
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
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
SO. 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
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)
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.
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
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL