06522 (SFD)bf 4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54"580 Riviera LA QUINTA, CALIFORNIA 92253
Owner
Address A� e
City Zip Tel.
rola Desert 92250 _563':-2828
Contractor
Nati*nai Hortgaxa
State Lic. I City
& Classif. 2881310 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
City( Zip ( State I
Lic. If
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section
70110) of Division 3 of the Business and Professions Code, and my license is in full force and
M
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Busness and Professions Code: Any city or county which requires a
Permit to construct, after, fnprove, demolsh, or repair any stnrcture, pnor to its issuance also
requires the applicant for such peril to file a signed statement that hes licensed pursuant to
the provisions of the Contactors 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- viotation of Section 7031.5 by any applicant for a permit
subjects the applicant to a cW penalty of not more than five hundred deters (5500).
❑ 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
Professions Code: The Cantradors Licose 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. It, however, the building
or improvement is sok/ within are year of completion, the owner -budder will have the burden
of proving that he did not build or irprove for the purpose of safe.)
❑ 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 bolds or improves thereon, and who contracts for
such projects with a contractof(s) licensed pursuant to the Contractors License Law.)
❑ 1 am exempt under Sec_ a & 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
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COM ON INSURANCE
(This section need not be completed it the pard is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, 1 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: N, after making this Certificate of Exemption you should become
subject to the Workers' Carpensafion provisions of the Labor Code, you must forthwith
comply with such provision or this permit shalt 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.)
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.
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
ateMailing Address
City, State, Zip
3 &7
No. 06522
LDING: TYPE CONST. OCC: GRP. -
P. Number PCA 3;itAt — Taxtr_t 74117-1
11 Description _
ct Description Phi ee _ P1= GiSR
REMARKS < . r:.a S r: 3 t... *4'4 I r.
AT:I , '51;2156. t;5 ...
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
ocNo.•
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$2p�o+� 42.4311/�
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 926.58
Const.
1,140.00
Mech.
31.50
Electrical
133,92
Plumbing
180.50
S.M.I.
17..01
Grading
Driveway Enc.
Infrastructure
$5,454.68
2,727.34 /
1,"s Credit.
2,727.34
TOTAL
$5.256.85
r
REMARKS < . r:.a S r: 3 t... *4'4 I r.
AT:I , '51;2156. t;5 ...
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—
2ND FL. Sp. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. Sp, FT. ®
DUCT WORK
ROCK STORAGE
GAR. Sp. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. I Sp. FT.
TEMP. POLE
WALL Sp. FT.
GROUT
DRINKING FOUNTAIN.
SO FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
=$
FLOOR DRAIN
MECHANICAL FEES
INAL INS —
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
U
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
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
GAR.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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
_ NO PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE—
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
ORMS
WER OR SEPT
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
OUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
INAL INS —
RAMING —�
FINAL INSP.
wROOFING -
�- W !�� .
U
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR.
RtgATHING 'J -i3-�v
MESH
4SULATIONISOUNDJ'
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL
I