06510 (SATT)4
P.O. BOX 1504
No. 06510
Building 78-105 CALLE ESTADO
Address 54-607 $sera LA QUINTA, CALIFORNIA 92253
Owner
a BUILDING: TYPE CONST.
Mailing ' OCC: GRP.
Address 42-600 Cook St., #200 _ A.P. Number PGA rest — ftgtcr 24317-1
•
City Zip Tel.
Palm Desert 92260 50-2528 Legal Description
Contractor Ph"e 31$s Plan 30%
Haational Mortgage Project Description
Address
Same e
City Zip Tela y
State Lic.258130 city 328 2826
& Classif. Lic. # Sq. Ft: No. No. Dw.-
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
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
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
• reason: (Sec. 7031.5,Busmess and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolsh, 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
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
• subjects the applicant to a cin? penally of not more than five hundred dollars ($500).
❑ 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 Contractors License Law does not apply to an owner of property who
builds or inproves thereon and who does such work honself or through his own employees,
provided that such improvements are not intended or offered for sale. It, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or improve for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Bus -chess 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & 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. O Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
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 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
NOTICE TO APPLICANT: ff. after making this Certificate of Exemption you should become
subject to the Workers' Covrpensation provisions of the Labor Code, you must forthwith
comply with such Prov -stuns or this permit shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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 abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity 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 Address
City, State, Zip
PERMIT
BY:
AMOUNT
Plan Chk. Dep.
Front Setback from Center Line
Plan Chk. Bal.
Rear Setback from Rear Prop. Line
802.21
Const.
972,00
Mech.
FINAL DATE
$2.51
Electrical
10/13/89
142.41
Plumbing
Validated by:
.204.00
S.M.I.
Validation:
13.65
Grading
Driveway Enc.
Infrastructure
$4,380.57
2,190.29
Less Credit
2,190.2.9
TOTAL
$4,407.06
.r _, • f ,' i .,
REMARKS _
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 /A/61
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. I SO. FT. ®
TEMP. POLE
WALL SO. FT.
GROUT
DRINKING FOUNTAIN.
SO. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as xoperty tax valuation
=$
FLOOR DRAIN
MECHANICAL FEES
� LYi
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
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, 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.L.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® V4c
HOUSE SEWER
t,,NSULATIONISOUND —6 '
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 R AIR COND. SOLAR
SBACK
PLUMBING
�^ UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /A/61
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FO S
EWER OR�C�A� v
ROUGH WIRING
DUCT WORK
ROCK STORAGE
ND. REINF
AS (ROUGH
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STE
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd.
$plusxE
=$
LUMBER GR.
1
NAL INSP.�i%�a9AICu.
� LYi
FINAL INSP.
CRAMING
OOFING 1 &I-
L� G�� � i
((l
J Q _ d� � /� �
Yi
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING ` �U
MESH
t,,NSULATIONISOUND —6 '
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL