05018 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-901 Riviera LA QUINTA, CALIFORNIA 92253
5,�»wian f:,etts-�,a,rao
Mailing '
Address .t
City .. Ip
Falco. Desert 92260 568--2820
Contractor
National Hortpavte
Address
State Lic. City
B Classif. 288130 Lic. # 328
Designer
Address Tel.
City (Zip (State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
.1000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirin that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busness 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 No 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 arid Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any v*Matton of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O 1, as owner of the property, or my employees with wages as their sole compensation, will
do the wor14 and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's 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 improve for the purpose of sale.)
❑ I, 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) 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 if 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 person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT If, after ma)mg this Certificate or Exemption you should become
subject to the Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or Otis permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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 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, State, Zip
No. 05018
UILDING: TYPE CONST. OCC: GRP.
.P. Number PGA Wast — Phase 2'Fr
egal Description
roject Description Plan P1
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
Issued by: Date 1.2/22/85 Permit
Validated by:
Validati
Sq. Ft. 3
Size 2� s
No.
Stories
No. Dw.
Units=
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
170, 32A
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 4907.78
Const.
610.50
Mech.
39.890
Electrical
92.01
Plumbing
114.00
S.M.I.
11.94
Grading
Driveway Enc.
Infrastructure
$3.833.51
1,916.76
LRRg Credit
1.916.76
TOTAL
S3.281.99
.: ; r^.-- 7 el e,
REMARKS
XV) 11�tA--) 34ilf�0)
30 -fed-.= x�
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
Issued by: Date 1.2/22/85 Permit
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
GRADE
RO GH PLUMB.��JJ
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. Ff.
FORMS
W R OR SE TA1k
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. Sp, FT. ®
'OUGH) /
C
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. Ff.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SQ Fr. a
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
MING
FLOOR DRAIN
MECHANICAL FEES
� � , J
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING '
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
SQ. Ff. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.'a.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TO+AL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
BACK
LIND PLUMBINGS Z
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE
RO GH PLUMB.��JJ
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
W R OR SE TA1k
ROUGH WIRING
DUCT WORK
ROCK STORAGE
UND. REINF.
'OUGH) /
C
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LU ER GR.
FINAL INSP.
MING
FINAL INSP.
O FING
VENTILATION
� � , J
Q� L �
REMARKS:
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GOR. FIREWALL
HIN
MESH
TION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL