06104 (RPL)Building 35-709 Riviera
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner I
He=v. Burdick
Address 3
am
City Zip Tel.
La Quiuta 92253
Contractor
Address
Tel.
State Lic. I City
& Classif_ 339970 Lic. # 251
Arch, Engr,
Designer
Address
city IZip I State
LICENSED CONTRACTOR'S DECLARATION
1herpby affn. mall I am ficersed miler provisions of Chapter 9 (commencing with Section
=I* Division 3 o the and Professions Code, and my license is in full force and
eHecL
S7d1ATUW- DATE
CPWNER43UHJMB DECLARATION
I hereby affmn that 1 am emnpt from the Contractors License Law for the following
reasOn: (Sec- 7031.5.19IMs rens and Rafess ons Cade: Any city or county which requires a
perms b crostrrt; altar, ayrOrg, darrwI f or repair any structure, prior to its issuance also
copses Che apprcait for such - I to Me a signed statement that he is licensed pursuant to
Me prouftios of rhe whirr ; License tat., Chapter 9 (commencing with Section 7000) of
6rrdmr 3 of Hie Business and Fholessars Codec, or that. he is exempt therefrom, and the basis
for Hhe Hoa Any - I lion of Section 7031.5 by 'any applicant for a permit
svAjec[s the appira I b a ciMpeafy Of nor more than five hundred dollars ($500).
❑ 1, as Owner of the property, Or my employees with wages as their sole compensation, will
do the worn, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Ptdestims Code.. The Cbritiaotark Licase Law does not apply to an owner of property who
buds or iDeem and who does such work himself or through his own employees,
prawided Oaf suchtYat h�rot®ehs are not intended or offered for sale. If, however, the building
or 6groraOerhI is =wino one yea d completion, the owner -builder will have the burden
a/prawirg e difoo bald orimp for the purpose of sale.)
❑ I. as owner of the property, am acct lively contracting with licensed contractors to con-
SbUct the project (Sec. 7014, Bisihess and ~essions Code: The Contractor's License Law
does not a qty b an owrha of property who brads or improves thereon, and who contracts for
such prejecls nth a contacbrN foasedpursad to the Contractor's License Law.)
❑ 1 am exempt hinder Sec. a b P.C. for this reason
Date owner
WOltlERT COMPENSATION DECLARATION
1 hereby affin. that 1 have a certificate of consent to self -insure, or a certificate of
Wends Compensation histwahce, or a certified copy thereof. (Sec. 3800, Labor Code.)
POlrcy N'opy Company
is filed with the city. O Certif-ed Dopy is hereby furnished.
7617E OF EXEMPTION FROM
WOWS COMPENSATION INSURANCE
swim need cot be oartpieted if the permZ is for one hundred dollars ($100) valuation
I certify that in the perfornanee of the wok for which this permit is issued, I shall not
tinin any mariner so as to become subject to the Workers' Compensation
f CaliforniaL
Date pie
NOTICE 70 APPLCANf- f aNar mating His Certificate of Exemption you -should become
sultOc b the RihdmW Cavpnss6xw provisions of the Labor Code, you must forthwith
comply with such, isors or Cis pehniT shat be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby aff-am that there is a construction lending agency for the performance of the
work for -lith this pemrt is issued. (Sec 3097, Ciel Code.)
Lenders Name
Lenders Addrers
This is abuDQmg permit inen properly filled Out, signed and validated, and is subject to
etrpirapon it wrtrk Ueerwda is aspen . for 18D days.
I certify that I have read this application and state that the above information is correct.
I agree to eon4h with aH city and county ordinances and state laws relating to building
carstructio4 and hereby aulhorfine representatives of this city to enter the above-.
mentioned property for' purposes
sim"of Date
Mailing Addrers
City. SMP- r4
BUILDING: TYPE CONST
Number
No.
OCC: GRP.:
Legal Description
Project Description Pool
06104
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
imated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$146.25
Const.
225.00
Mech.
24,00
Electrical
30.00
Plumbing
27.09+
S.M.I.
1.54
Grading
Driveway Enc.
Infrastructure
,i
TOTAL
REMARKS _V-141Ty aiW 11 4l ALI
T-� 41
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
7/20/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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 a 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V/ec
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK -
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -plus-x$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FI SH GRADING
NAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t