06887 (BLCK)P.O. BOX 1504 N O .
Building 78-105 CALLE ESTADO
Address 54-065 .Riviera LA QUINTA, CALIFORNIA 92253
Owner - -
Mailing - "
Address 62•-600 wiz Svtzteets.Snfta 20.4"
City Zip Tel. �.
Ya�im Desert 92260
Contractor
Sam _
Address
BUILDING: TYPE CONST,-- - OCC'. -GRP...
A:P. Number' . PGA Xit St The CaUerie s
Legal Description Ph nae 2R on Riviera
Project Description 3t920' liFiea$ feet of common area
b1bek 'Wall TM
City
Zip
Tel..
State Lic.
City
& Classif. ,
Lic. #
Sq. Ft.
Size i
No. No. Dw.
Stories - 1 • Units -
Arch., Engr.,
New ❑ :Add ❑
-
Alter ❑ Repair ❑ -Demolition ❑
Designer
Designer
Address,
Tel. '
„ 'City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapfer 9 (commencing with Section
7000) of Division 3 of the�&isiness and Professions Code, andimy license is�in full force and
effect .'0�, Ai :l,�Y
•.- .
SIGNATURE R.jr "-. ... _ -•.v - ! '" DATE
' OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031-5,8usness and Professions Code: .Any city or county .which requires a -
permit to constrict, after, improve, demolish, or repair, any structure, prior to its issuance also
requires the appicad for such pemm3 to foe a signed statement that hes licensed pursuant to
the provisions of Me Contractors license Law. Chapter 9 (commencing with Section 7000) of
Division 3 of Me 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 appicant to a civilpenally of Trot more than five hundred dollars ($500).
❑ 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, Suisness and
' Professions Code: The Contractors 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 of intended or offered for safe. 0, however, the building
or u provernent is sold within one year of completion, the owner -budder will have the burden,
_ of proving that he did not buil or improve for the purpose of sale.)
Estimated Valuation
+
$981400
- -
PERMIT -
AMOUNT
Plan Chk. Dep.
- -
Plan Chk. Bal.
Const. '$630.50
,
Mech. `
E I ect tical
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to Corr.
struet the project (Sec. 7044, llvsumess and Professions Code: The Contractor's License Law
S.M.I.
G o
- V.v6 r
does not apply to an owner of property who builds or improves thereon, and who contracts for
such
supnojads witlm a contractor(s) licensed pursuant to the Contractor's license Law.)
❑ 1 am exempt under Sec_ w_ & P.C. for this reason
Grading
Driveway Enc.
Date owner
Infrastructure
"
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificaterof^consent to self -insure, or a certificate of
Workers Compensation Insurance, ora -.certified -66y thereof. (Sec. 3800, Labor Code.)
Policy No Cbmy / j� �.•
„
❑ Copy is filed with the city- ❑Certified copy is hereby furnished.
TOTAL
{+•# .u�!'l .t�l3F.LIr�f�'�. ,
'
CERTIFICATE OF EXEMPTION FROM -
WORKERS' COMPENSATION INSURANCE
REMARKS
r'm r • •^ i
-
- •u.r-u tvx VW
(This section need not be eomplated ff 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
hronCE TO APl'UCANT: d 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 orflus permaShall bedeemed revoked .
ZONE: BY:
-
Minimum Setback Distances: '
-
Front Setback from. Center Line
Rear Setback from Rear Prop. Line
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.)
Lenders Name
Side Street Setback from Center Line
=
Side Setback from. Property Line
Lenders Address
` This is a building permit when property filled out, signed and Validated, and is subject to
expiration if work thereunder is suspended for 180 days.1/17/90
FINAL DATE
IN
IN y
INSPECTOR
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 laves relating to building,
construction, and hereby authorize representatives -of this city' to enter the' above-.
mentioned property for inspection purposes
Issued by: '
Validated by:
Date Permit
+
'
Signature of applicant Date r
S '
.. Mailing Add r� -
Validation: '�`• - -
.. �• "!etc 1 y _•m +"•.,, _ ' ' �' , •�
City,. State, Zip
.. .. • - •• �- .. -. - ti
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. I SQ. FT. ®
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
SQ FT ®
FRAMING
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FANEVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
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'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
INSULATIONISOUND
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL