06024 (RER)Building
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner Hr i Mahler �{ � I
4�Y.i _
h.hnrrhrry ..
Address Sail!@
City U Qtdnta Zip Tel.
92M I
Contractor
__68-W Perez Pd. Suite E
City Zip Tel.'—..
cat City 92234 324-5741/$68—A
State Lic. City r
& Classif. B3006650 Lic. # 1425
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
"1 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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
1 hereby affirTn that I am exempt from the Contractors- License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
pemrit to construct, after, improve, denmfish, or repair any structure, prior to its issuance also
regiiiines the for such
to 11116 a signed statement ftf he is licensed
the rovsions offf thet Contractor's License./aw. Chapter r 9fcordi ening with Sectiopursuant7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any viofatim of Section 7031.5 by arty applicant for a permit
SI the applicant to a civilpenally of not more than five hundred dollars (E500). -
❑ 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 himseH or through his own employees,
provided that such improvements are root intended or offered for safe. If, however, the building
or irprovement is sod within one year of completion, the owner -builder will have the burden
of proving that he did not build or Improve t the purpose of safe.)
❑ 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 irproves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. a_ & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that 1 have a aertificete of consent�t self -insure, or a certificate of
WdtWs Compensation Insurance, or a certifiedacopythereof„(Sec. 3800, Labor Code.)
Policy No Company z., ' - "r -,r
❑ Copy is filed with the city. ❑ Certified copyyis hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be conpleted ff the permit is for one hundred dollars ($100) valuation
or fess.)
certify that in the performance of thg 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
N077CE TO APPLICANT: ll, after mailing this Cerfifwte of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply wfth such provisions or this permit shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
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
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 1 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
No. 06024
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number Coif Estates
Legal Description
Project Description Re"'v.bde•
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter [Z Repair ❑ Demolition ❑
Estimated Valuation 13>,600.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
99.45
Const.
153.00
Mech.
Electrical
25.00
Plumbing
INSPECTOR
S.M.I.
6-21'-89
Grading
Date - Permit
Driveway Enc.
Infrastructure
Validation:
TOTAL
) �!
REMARKS
a., c, �^-*� : tx+ .:ro �f► rye f. a an�r2tn�:; Ksx1
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
6-21'-89
Issued by:
Date - Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) //.V,// 0 O
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP. /0-y 70
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
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.
SO. FT. ® c
BATH TUB
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 31ic
HOUSE SEWER
FINISH GRADING
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL) //.V,// 0 O
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus X$
=$
LUMBER GR.
FINAL INSP. /0-y 70
FRAMING
FINAL INSP.
ROOFING
/(�/� ///►A
' " 02,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINTTIALS
GARDEN WALL FINAL
1