06521 (SFD)4
P.O. BOX 1504 No. 06521
Buildin78-105Addrress 54-701D Riviera LA QUINTACCALIFORNIA 92253
Owner
Mailing
,w Pda>gsr BUILDING: TYPE CONST. -OCC '
ONST.OCC: GRP.
Address 42-600 Cook St., #200 A.P. Number FGA West - Tract 24317-1
CityZip Tel.
$� Desert 92260 1 568-2828 Legal Description
Contractor
Project Description Ma SA PIGi$R
National mart a e _
Address
fi
City Zip Tela
State Lic. City
& Classif. 289130 Lic. # 328. Sq. Ft., 3401 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 1 am licensed under provisions of Chapter 9 (commencing.with Section
7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and
effec�
_SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following $242,430
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, mrprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to PERMIT AMOUNT
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 Plan Chk. Dep.
subjects the applicant to a civil penafty o! not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. $ 926.58
do the work, and the structure Const. is not intended or offered for sale- (Sec. 7044, Buisness and 1 �A An
Professions Code: The Contractor's License Law does not apply to an owner of property who y - (40.00
builds or $� improth
ves thereon and who does such work himself or through his own employees,
provided that such movements are not Intended or offered for sale. f/, however, the building Mech.e0
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 183.92 Q nil
of proving that he did not bu#d or inprove for the purpose of sale.) 183. 92
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing }���fl
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law y A
does not apply to an owner of property who, builds or improves thereon, and who contracts for S.M.I. Z7.liJ
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure 85.5,454.68 2.727.34
Lana C "r Air 2,727.34
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 S5,256.85
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be c p ( )
completed i/ the exit is for one hundred dollars 5100 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, ff, after making this Certificate of Exemption you should become ZONE: BY:
subject to 'the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
1hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSS
expiration it work thereunder is suspended for 180 days- 10/13/89
1 certify that 1 have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
LAB GRADE r
ROUGH PLUMB.
YARD SPKLR SYSTEM
r
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMSWER
MOBILEHOME SVC.
BAR SINK
POR. gQ, FT. ®
ROCK STORAGE
F D. REINF.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT.
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
1600FING /-07-7-07()
v
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TCTAL 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 PLUMBING16
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE r
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSWER
OR SE lG IfK ROUGH WIRING
DUCT WORK
ROCK STORAGE
F D. REINF.
0,45AS (ROUGH)METER
LOOP
V
HEATING (FINAL)
OTHER APPJEQUIP.
NF. STEEL
GAS (FINAL)
TEMP. POLE
ROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
1 -AL INSP. .��
FRAMING ��/
FINAL INSP.
1600FING /-07-7-07()
v
O ✓ Cl /l
!�-
�` / C
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
G6ATHING
MESH
?LINSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
i
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FIN&L
l