06537 (SFD)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-790 Riviera LA QUINTA, CALIFORNIA 92253
Mailing
Address 42-630 Cook St,, #200
City Zip Tel.
.. Palm Dessert 92260 568-2828
Contractor
National Mortgage
Address
Zip I Tel.'
State Lic. I City
& Classif. 2€t8230 Lic. # 328
Arch., Engr.,
Designer
Address' I Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
700p) of Division 3 of the Business and Professions Code, and my license is in full force and
effecL
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business 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 permft to Me 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 civil penalty or not more than rive hundred dollars ($500).
❑ I, 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 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 improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or krprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Busyness 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 contractors) 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. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) vatuaaon
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 California
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the tabor 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
Lender's Address
This is a building permit when properly 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 Address
City, x State,, Zip
No. 08537 32—
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PCA est -- tract 24317-1
Legal Description
Project Description Plan C3A. Fhasq i
REMARKS tt _.,,,. r+�� �•jn -1r^I y; tT ..a
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
10/16/89
Issued by: Date Permit .
Validated by:
Validation:
Sq. Ft. M31No.
Size-
Stories
No. Dw.
Units -
New ❑ Add ❑
Alter ❑
Repair ❑ -Demolition ❑
Estimated Valuation
$272.643
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$1sOla-
Const.
1 ��
Mech.
$1 .90
Electrical01110
, '
Plumbing
KI
S.M.I.`
•�
Grading
Driveway Enc.
Infrastructure
16 onma
. rr .•
Leas Credit
TOTAL
�Ru•,
1 t ' .k , {
REMARKS tt _.,,,. r+�� �•jn -1r^I y; tT ..a
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
10/16/89
Issued by: Date Permit .
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEr.
1ST FL. SQ. FT. ® $
UNITS
GRADE L (
2ND FL SQ. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
ND. REINF
AS (ROUGH) /G METER LOOP
DRAINAGE PIPING
CAR P. I SQ. FT. ®
OTHER APPJEOUIP.
REINF. STEE
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as F roperty tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
v� -` �/C
%► tl" �J - `-� `� ���� ' qO
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 iFORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.B.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 6 AIR COND. SOLAR
SET ACK
LIND PLUMBING UNDERGROUND
A.C. UNIT
COLL, AREA
GRADE L (
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
F
,#M!,,--,
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
ND. REINF
AS (ROUGH) /G METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEE
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.fNAL
INSP. el
94 RAMIN —(% f%
FINAL INSP.
OOFING i
v� -` �/C
%► tl" �J - `-� `� ���� ' qO
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
BATHING
MESH
GL INSULATIONISOUND(:Z-+jS -QX)
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL