11185 (SFD)f .
•4
.4a
P.O. BOX 1504
Building4�-69fl SEELEY 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
ACACIA
Mailing
Address 1021 DASTANCUURY
City lZip ITel.
ACAICIA
SAME
City
State Lic. City
& Classif. g 293434 Lic. # 1612
Arch., Engr.,
Designer
Address Tel.
City IZip I State I
Lic. #
��ICENSED CON AC 4R'S DECLARATION
I hereby affirm that,l am licensed under pr , isions of Chapter 9 (commencing with Section
7000) of Divi—span 3 of the rB,uusiinness a�nnd Prroofessions Code, and my license is in fullffor elaand
effect. !V_f 1; l7lrl Xfi,�( 'A31,92:
SIGNATURE :1 14 ;DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,ausiness 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 file 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 of not more than five hundred dollars ($500).
O 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, Suisness 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 coir
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of propertywhobuilds 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
O Copy is filed with the city. O 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 making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor 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, State, Zip
No. 11185
LDING: TYPE CONST. OCC: GRP.
P. Number
Description
Description
C3 R21 TRACT 23268 LOT 128
PLAN C-3 PURSE III
Sq. Ft. 1927 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuation 1059733
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$552.00
Const.
660.50
Mech.
60,008
Electrical
114.4 7,
Plumbing
144.50
S.M.I.
7.42
Grading
Driveway Enc.
Infrastructure
2378.99
ARTS IN PUBL=w
26600
TOTAL
3942,88
REMARKS
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. S0. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I S0. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
a
YARD SPKLR SYSTEM f
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.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET-
COMPRESSOR HP
POLE, TEMIPERM
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 ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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 GOND. 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
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
�o4
oovi%
CITY OF LA OWNTA
DEPARTMENT OF -Pt W41NG & DEVELOPMENT
BUILDING DIVISION
564-2246
24-HOUR NOTdRq 6gtW%offRTIONS
Owner ACACIA JUL 4 1 1992
Contractor SAME FINAIQ MEAT
Permit Number 11185
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
"ADDRESS 44-690 SEELEY
TYPE OF INSPECTIONPATE
INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
1
1/
GROUND PLUMBING
3
Z
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL AB
VE
A.S.5EEN SIGNED
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
c b�
HEATING & VENT - A/C
FIREPLACE
O.K. TO WRAP i,
GROUT O 4' O 8' FT
FRAMING
INSULATION h/
PRE -ROOF
COVER NO WORK UNTIL ABOVE H S B EN SIGNE
DRYWALL INTERIOR j
EXTERIOR LATH 1 114..,
POOL PRE PLASTER
POOL FENCE & GATE
SEWER StrqM4hNK 7
HUU51t NUMBEH5
JOB COMPLETED
TEMP POWER
ABOVE APPROVALT5 NdT INCLUDE RIGHTTO
TURN ON UTILITIES OR OCCUPY BUILDING
4!88