06339 (SATT)4
P.O. BOX 1504
Building 78-105 54-709 Riviera LA QUINTAC
Address CALIFORNIA 92253
Owner
9mri se Comalay
Mailing
Address 75-005 Country Club Drive _
City Zip Tel.
. Palm Desert 92260 568-2825
Contractor
same
No. 46335 30)'
BUILDING: TYPE CONST. OCC: GRP._
A.P. Number 1. KA West — Pbase 303
Legal Description
Project Description Tract 24317-1, Plan 3EIMit
City Zip Tela
State Lic. 288130 City 32� 2$26
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City IZip I State
Lic. #
r LICENSED CONTRACTOR'S DECLARATION
hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7800) of livision 3 of the Business and Professions Code, and my;license is in full force and
effect +f f.' ' L. '09
'SIGNATURE
i'SIGNATURE — DATE
j OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiress and Piolessions Code: Any city or county which requires a
Pam* to construct, after, irprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such pemrd to hie 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 Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exerption. Any violation of Section 7031.5 by any applicant for a permit
subjects the appicant to a civilpenally of rpt 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
bu*b 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. If, however, the building
or I provement is sold wNm one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ 1, 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 builds or improves thereon, and who contracts for
such projects with a contractor(s) ioensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sea R. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
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.
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: ft, after making this Certificate of Exemption you should become
subject to the Workers' C.orrpensation Prov -cions of the Labor Code, you must forthwith
Campy with such provisions or this perm* 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.)
Lenders Name
Lenders Address
This is abuilding permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 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
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Estimated Valuation
e s
$19b,.692
PERMIT
AMOUNT
Plan Chk. Dep.
Issued by:
Date Permit
Plan Chk. Bal.
022.2
Const.
972.00
Mech.
82.50
Electrical
142.41
Plumbing
204.00
S.M.I.
13.65
Grading
Driveway Enc.
Infrastructure
$4*380.57
2,190.29
Lees Credit
2,190.21
TOTAL
$4,407.06
REMARKS
d' -rix -t :1z < A
tri Vi4 AQ-!IZZ_0 , -to
IQ t<fy.7ti I
I U t Ri. X q flu i VQ
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
4/10/89
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL, AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
SEWER O Z@
ROUGH WIRING.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
ND. REINF.
AS (ROUGH) �� a% G
[
DRAINAGE PIPING
CAR P. I SO. FT.
HEATING (FINAL)
OTHER APPJEOUIP.
WALL SO. FT.
GAS (FINAL)•.•
DRINKING FOUNTAIN.
SO FT @
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
r
INAL INSP.
!
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OOFING : 16�v
v
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTi AL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE ., PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBING !
UNDERGROUND
A.C. UNIT
COLL, AREA
LAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER O Z@
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
ND. REINF.
AS (ROUGH) �� a% G
[
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
EINF. STEE
GAS (FINAL)•.•
TEMP. POLE
V
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
-plus-x$-=$
LUMBER GR.
r
INAL INSP.
!
FRAMING� G
FINAL INSP.
OOFING : 16�v
v
f� ! /+
/ // _�j) n�
lJ 6C
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
tAgSULATION/SOONDom.
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL