03902 (SFD).Qum&
03902
P.O. BOX 1504 t
Building 78-105 CALLE- ESTADO
Address 79-755 Fiesta LA.OUINTA,.CALIFORNIA-92253
von Howmu
Mailing
Address
City lZip
Legal Description
Project Description$
y y Y+ a .• r ♦ w w Jr
Tel.
City
Lic. # lSq.Ft. 2026 No. No. Dw.
It Size Stories Units
CityI Zip I 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 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
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
Division 3 of the Business and Professions Cade, 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
r_ subjects the applicant to a civil penalty of not more than rive hundred dollars (8500).
❑ 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
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,
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-
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
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
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
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 Date
Mailing Address
City, State, Zip
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
I
Pool and block wall not i4cluded
Estimated Valuation
Qo1U
PERMIT
A4 OUNT
Plan Chk. Dep.
:250000
Plan Chk. Bal.
127.97
Const.
448.00
Mech.
36.00
Electrical
89.61
Plumbing
105.00
S.M.I.
7.39
Grading
20,00
Driveway Enc.
20.00
Infrastructure
2, 365.34 ,
l� �,�yy
Lli�v
TOTALii�
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
. 4/29/98
Issued by: Date Permit
Validated by:
Validation:
1
WHITE - FINANCE, PINK - APPLICANT, GREEN BUILDING, GOLDENROD -ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
iST FL SO FT rp S
UNITS
XREA
_SLAB GRADE
ROUGH PLUMB
YARD SPKLR SYSTEM
,e
2ND FL SO FT. a
-�' STORAGE TANK" `"1� `'°•'""
FORMS -WS
EWER OR -SEPTIC 1�- ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
y
POR SO FT. alt
FOUND. REINF.
GAS (ROUGH)
METER LOOP
GARSO. FT. kt
POWER OUTLET
ROOF DRAINS
;•; F�
-
- REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
'4•
CAR P. SO FT. fq
GROUT
-WALL-- - 'SO FT. @
-
DRINKING FOUNTAIN
FINAL INSP.
SO. FT. a
URINAL
`'`��• '
2= -•++ r e
- ESTIMATED CONSTRUCTION VALUATION $
$
WATER PIPING
•----' -
NOTE; -Not to be use0 as property tax valuation -
FINAL INSP.
FLOOR DRAIN
FINAL INSP.
MECHANICAL FEES
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..__.._...�..._.._..._.�_._, _ _.___. y't' .1'?;y4•:, �,
K)ii.{JI!i.'.j
WATER SOFTENER
.•.a
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE' '--"" ' `-^'-' - DRYER
ftRE"ZONE -ROOFING --` -
GARBAGE DISPOSALS"°T`
FURNACE --UNIT WALL FLOOR -.•SUSPENDED
LAUNDRY TRAY.
AIR HANDLING UNIT CFM
"SPARK --ARRESTOR, .__.._____..._•._
KITCHEN SINK
"•
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
LATHING
a
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM"'- ` -'--'FORCED GRAVITY
AMPERES SERV ENT
SHOWER
.,1*; ; „�_ •,1� .
BOILER. B.T.U.
SO. FT. 0 c
BATH TUB
�. ; ,• -
SO. FT. g• c
WATER HEATER
•:':�"'G?
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESIO C. 11/4 c
SEWAGE DISPOSAL
--
SO.FT.GAR @ V4c
HOUSE SEWER
::•,>.3•, r ,
INSPECTOR'S SIGNATURESIINITIALS
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 8 AIR GOND. - -SOLAR--
SETBACK'
ROUND PLUMBIN
UNDERGROUND
A.C. UNITCOLL.-
XREA
_SLAB GRADE
ROUGH PLUMB
,.BONDING:
HEATING (ROUGH)
-�' STORAGE TANK" `"1� `'°•'""
FORMS -WS
EWER OR -SEPTIC 1�- ROUGH WIRING
DUCT WORK
y
ROCK STORAGE, rte•
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
' OTHER APP:IEOUIPYC'O" , \r
- REINF. STEEL
GAS (FINAL)
•�I•.TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND.BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus •
......... ._..
., _ ..-.. ..,•
k$ -$
LUMBER GR.
FINAL INSP.
-FRAMING -
FINAL INSP.
ROOFING
/ I �/`� Vt.. %_ _ ,tyCp �/��
I
,
� lippeV tv/vl`r>r
t__ _... _...... ..-._._
,� � �,y.. _: _,•,. - ..
;,•, ' i 1
AQE�. •2 ( -1
- ---.__....._._.. .. _ _ .. .__ ; .1, - ,_.,, t
..__.._...�..._.._..._.�_._, _ _.___. y't' .1'?;y4•:, �,
K)ii.{JI!i.'.j
REMARKS:
.•.a
_ VENTILATION
ftRE"ZONE -ROOFING --` -
-—._....._ ..-...._.._._..._ ...
FIREPLACE -- - --._
"SPARK --ARRESTOR, .__.._____..._•._
,'i_,.
GAR~ FIREWALL
_ .. .,.. ,.
LATHING
a
MESH
INSULAT10NISOUND
.�-•..
FINISH GRADING
�. ; ,• -
CFINAL INSPECTION/ /J
...CERT -'p -'- -.. _.. _....__...._.....
.. ....: ��•�: .. „ r1," ,... � vi
FENCE' -FINAL __....,..
::•,>.3•, r ,
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
_..7;:: , -;r-P:' ;1= A64 .3�)1--;'!i) 3'8C�,2.3aZA G'✓t114! i*.110i1 .e 3.@IQ.1;1, tV • 1.43, 5 4.A ):.!I'M p. > : i , A'..A;4; , - -T IiIV`;
P.O. BOX 1504 APPLICATION ONLY-,
Building ,RFs 7' �Q 7&105 CALL ESTADO' ��"3 S., r 1 I •
IN
Address / \ LA QUINTA, CALIFORNII�A 922531 �.�, ,{ ay
Owner-- {its
I _-) O N -f 0 1N A2
BUILDING: TYPE CONST. OCC. GRP. t
/ .. .
A.P. Number /42 - QD
`„r` �' \ 1'
Legal Description �+, Z T NO - -;2EO 2L o T % O
Project Description
Mailing /
Address �/, ��
�City�
Tel.
��, �
Contractor
(_-Wp Q
Address
City
Zip /
Tel..
C-S'F
State Lic.
& Classif.g %7 r
City
SIV -1
Sq. Ft. / No. No. Dw.
Size Z fj Z t0 Stories Units
Arch., En r.,
DesignerA ""New
❑ Add ❑� Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
(1�
Zip i.("t''
�
LStie
-tt#
� f
ii 1� 1r' 1 A, f LJ
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 91commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is In full force and
effect.
n
SIGNATURE �-'� i `.d DATE-,'�^
i
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buslness and Professions Code: Any city or county which requires a
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
Divisfon 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 rive 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
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,
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.)
Estiina ed Valuation
PERMIT AMOUNT
Plan Chk. Dep. 2 j
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing r '
O 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.I. 10
t'
Grading _P
Driveway Enc.
Date owner
Infrastructure j p- eta
J `
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.)
( 7.
Policy No. Company
❑ Copy Is filed with the city. O Certified copy, is: hereby furnished.
/
TOTAL �7_ !;-0, 0
CERTIFICATE OF EXEMPTION FROM )
WORKERS' COMPENSATION INSURANCE/?•/2 (J
REMARKS r1)
(This section need not be completed if the permit is for'one hundred dollars ($100) valuation
or less.) r• G
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 California.
t
t —}
1
Date_1
O
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, �r•
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby 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 Setback from Property Line
Lender's Name
FINAL DATE INSPECTOR
Lenders 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.
Issued by: Date Permit
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
BUILDING DIVISION
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES NO.
OW
PLUMBING
1ST FL. Z SQ. FT. ® $
Y UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL.SO. FT. ®
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
METER LOOP
BAR SINK
POR. SQ. FT. ®
Jrd
GAS (FINAL)
TEMP. POLE
GAR. SQ. FT. ® O
POWER OUTLET
GROUT
ROOF DRAINS
SERVICE
FINAL INSP.
DRAINAGE PIPING
CARP. SQ. FT. 0
GRADING
cu. yd.
$ Plus -x$-=$
WALL SQ. FT. '
FINAL INSP.
DRINKING FOUNTAIN
FINAL INSP.
ROOFING
URINAL
SO. FT. ®
REMARKS:
ESTIMATED CONSTRUCTION VALUATION $
VENTILATION
WATER PIPING
NOTE: Not to be used as property tax valuation
FIRE ZONE ROOFING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
FINISH GRADING
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
�(,
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
Zi
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
INSPECTOR'S SIGNATURES/INITIALS
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1114 cjk�i
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEECONST. FEE
ELECT. FEE
1
SMI FEE PLUMB. FEE
77_I
s it -
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL