002687 (BLCK)P.O. BOX 1504 No, 002687
Building 78-105 CALLE ESTADO
Address 51-525 Ame{j.S a Y'4� X*)ZR LA QUINTA, CALIFORNIA 92253
Owner
Jamas
Mailing BUILDING: TYPE CONST. OCC. GRP:,
/
Address A.P. Number
City Zip Tel. 1 I
Lai nta 92253 Legal Description #
Contractor Project Description
�>at�
BY:
Minimum Setback Distances:
City..
8
Zip _
Tela ..,
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from.Property Line
FINAL DATE
State Lic.
City
Date Permit
Validated by:
& Classif.
Lic. #
Sq. Ft. 1ft
No. No. Dw.
A66%4
11 7 20.00 CK
�
Size -Stories
Units
Arch., Engr:, •-- ••
Designer
New p Add ❑
Alter ❑ Repair ❑ Demolition .0
Address
Tel
City
Zip
State
Lic. #
r,.
10V A ft
�
of 6—f i9b wood foZe-
LICENSED CONTRACTOR'S DECLARATION
• .
Z
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
Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following
eAngy
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a'
t"-JJVVYY�VV
'
permit toafter, 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 -
- PERMIT
AMOUNT
the provisions of the Contractor's 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 exemption. Any violation of Section 7031:5. by 'any applicant for a permit
Plan Chk., bep.
._
-
subjects the applicant to a civil penalty of'not more than five hundred dollars ($500). - -
Plan Chk. Bal.
O 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
COr1St.
�Stf��/�n�
Professions Code: The Contractor's License Law does not apply to an owner of property who
,46 .00
builds or improves thereon and who does such work himself or through his own employees,
Mech.
proyided 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
Electrical
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the properly, am exclusively contracting with licensed contractors to con-
Plumbing
_
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
S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) f* -
J0,
Gradin g
0 1 am exempt under Sec. B. & P.C. for this reason
/ r r
'�
Driveway Enc.
Date !4 r.i / Owner .' /� -- —
Infrastructure
WORKERS' COMPENSATION DECLARATION
l hereby affirm that I have'a'certificate of consent to self -insure,.& a certificate of
Worker's 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
24.00
CERTIFICATE OF EXEMPTION FROM
REMARKS
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.
Dat '
'
e 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.)
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 In is, correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives.-Ofthis city to enter the above-
mentioned property for inspection purposes.
Signature of applicant t .0f Date
Mailing Address i r
City, State, Zip
HARD COPY
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 Permit
Validated by:
Validation:
A66%4
11 7 20.00 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
COLL, AREA
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROUGH WIRING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
DUCT WORK
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.
SO. FT. ® c
BATH TUB
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
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 APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
-Plus-X$-=$-
lusx$=$ROOFING
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
_
DEC
17 1981
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SO U N D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL -
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL