06524 (SFD)T 4b4hf °�:W a'"
Building _ 54-430 Riviera
w midi
stmrise fatty
-Mailing
Address 42-'600 Gook St., 9.2€30
City Zip Tel.
Palm Desert 92... 1
Contractor
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City Zip Tel.- - "
State Lic. City
& Classif. 288130 Lic. # 328
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7010) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that 1 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
permit to construct, alter, improve, demolish, or mpab any stricture, prior to its issuance also
requires the applicant for such perm# to fie a signed statement that he is licensed pursuant to
the provisions of the Contractors License law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Prolessiom 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 civilpenalty of rrot more than the 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, 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 sate. If, however, the building
or improvement is sold within one year of conpation, the owner -builder wig have the burden
of proving that he did not bund or improve for the purpose of sale.)
❑ 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 buikis or improves thereon, and who contracts for
such projects with a contractor(s) gcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. w_ & 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the pemx7 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 makig this Cerhticate of Exemption you should become
subject to the Workers' Compensation provsions of the labor Code, you must forthwith
comply with such provisions or this permit shall be deemed rovoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction tending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
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 certify that I have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives orf this city to enter the above,
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
city, State, zip
No. 06524 Atl
BUILDING: TYPE CONST. OCC: GRP.
P. Number Rest Tract 24317-»1
Legal Description
Project Description_ �I._ � PiAn r -In
REMARKS �t i
rct :3�1"k `�%t`4 }'7'tl�`Lt1 I f 1,
C� � �?
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
10/13/89
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft. 3401
Size
No.
"`'Stories
No. Dw.
Units'
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
r -
Estimated Valuation
42q ``3r�01�
y7�S.YI� � °d.7ii
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
1, 140. W
Mech.
81,50
Electrical
183..92
Plumbing
180.50
S.M.I.
17.01
Grading
Driveway Enc.
Infrastructure
$5,454.63
2,727.34
Less Credit
2,727.34
TOTAL
$5,256.88�z
-' __:r�� . ~..:•
REMARKS �t i
rct :3�1"k `�%t`4 }'7'tl�`Lt1 I f 1,
C� � �?
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
10/13/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE /� 3_
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
(ROUGH)611-12
(
METER LOOP
DRAINAGE PIPING
CAR P. I SQ. FT.
REINF. STEEL
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINALINSP. 6-�
V
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING'
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1 V/i c
SEWAGE DISPOSAL
FENCE FINAL
SQ.FT.GAR ® V4c
HOUSE SEWER
GARDEN WALL FINAL
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
UND L'UMBING
% UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /� 3_
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
44WER OR SE/I///t�..T� ROUGH WIRING
DUCT WORK
ROCK STORAGE
n
G1FOUND. REINF. 1a` / RC2? gAS
(ROUGH)611-12
(
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.
FINALINSP. 6-�
V
AMING
FINAL INSP.
ViOFING
-50 �� _
To
^
REMARKS:
VENTILATION
FIRE ZONE ROOFING'
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
qi�CATHING -11;20
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL