06539 (SFD)4
P.O. BOX 1504 No. 06539
Building 78-105 CALLE ESTADO
Address 54-670 Riviera LA QUINTA, CALIFORNIA 92253
Owner
suiwiSe comp BUILDING: TYPE CONST. - OCC: GRP. -
Mailing
Address 42-601 Cook St.. #200 PGA taaat - Tract 24317-1
A.P. Number
City Zip Tel:
Palm Desert 9226 568--2828 Legal Description
Contractor Phase '� MA
Mortgage
Project Description
Address
Sate
City Zip Tela
State Lia 288130 City 328 3831
& 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
effecL
SIGNATURE - DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated
reason: (Sec. 7031.5,6usiness and Professions Code: Any city or county which requires a
permit to construct, after, 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 Contractors 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. Dep. -
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 41010.30
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and 5aQ
Professions Code: The ContractorConst. Contractor's License Law does not apply to an owner of property who q C0
builds or rnproves thereon mod who does such work himself or through his own employees. Mech. y .50
provided 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 -balder wig have the burden Electrical 200.45
of proving that he did not build or'reprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to coo- Plumbing 198.50
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law 19.11 C� 7
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 19. i1
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec B. 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure $6,i?titi.t34 3 .titJ
Leas Credit ,00v.u0
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 furnished.
TOTAL $5,754.86—
CERTIFICATE
5,7 4.S
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed d 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 pperson in any manner so as to become subject to the Workers' Compensation
Laws of Calnf0 a.
Date Owner
NOTICE TO APPLICANT: H, 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
Lenders 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
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 DATEINSPECTOR
10/101/89 9
Issued by: Date Permit
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
B GRADE ,l �v 77
2ND FL SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FO D. IN
DRAINAGE PIPING
CAR P. I SQ. FT.
OTHER APPJEQUIP.
STE
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SQ FT ®
ROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
-$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
/
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1V4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Lc
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
S ACK
GROUND PLUMBING /
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE ,l �v 77
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPTI
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FO D. IN
GAS (ROUGH)/�/ METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
STE
GAS (FINAL)
TEMP. POLE
ROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
AL INSP.
�RAMING
FINAL INSP.
OOFING OR%�O
/
? c7 C)
L v 4
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
FIREWALL
�,,//GAR.
Gt✓Il.6THING
MESH
qUIJNSULATION/SOUND-/-
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL