MISC (05905)79555 Marigold Lane
05905
Building
Address
Mailing
Address
City
Contractor
Address
T4ht
P.O. BOX 1504 No, 05905
78-105 CALLE ESTADO
79--55$ MIirigold Lane LA QUINTA, CALIFORNIA 92253
Lin O_it~ttfi Associates BUILDING: =TYPE CONST. OCC: GRP. -
43-875 Washington St.
Zip p Tel.
P.D. 9Z2si-V
.G. Williiwns ltev..
State Lic. City
& Classif. 493919 Lic. # 12;1
Arch., Engr.,
Designer
Address Tel.
A.P. Number
Legal Description se xa Lot 36
Project Description Pia -4A Cactus 'Phnom
A
Sq. Ft. 1887 No.
Size Stories
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
700 W Division 3 of the Business and Professions Code, and my license is in full force and
effect
SIGNATURE DATE
OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for the following
r son: (Sec. 7031.S,Business and Professions Code: Any city or county which requires a
-'perrnft to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the appicant for such permit to hie a signed statement that he is licensed pursuant to
the provisions of the Conbactors License taw, Chapter 9 (commencing with Section 7000) of
Oivision 3 of'the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged ex w tion. Any violation of Section 7031.5 by 'any applicant for a permit
subjects.tlie appScant to a civi penalty of not more than five hundred dollars ($500).
0 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 Contactors License Law does not apply to an owner of property who
builds or reproves thereon and who does such work himself or through his own employees,
provided that such inprovements are not intended or offered for sale. ff. however, the building
or irproverment is sold within one year of completion, the owner -budder wig have the burden
of proving that he did not Indd or krprove for the purpose of sale.)
0 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 bnproves thereon, and who contacts for
such protects with a contractor(s) licensed pursuant to the Contactor's,Ucense Law.)
0 1 am exempt under Sec_ R. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
ID Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This sermon need not be eonoWed B Me 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: H, after malting this Certificate of Exemption you should become`
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Comply with such provwons or His permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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 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. DIN.
Units -
Newt Add O Alter 0 Repair 0 Demolition 0
Estimated Valuation 881500.00
PERMIT
AMOUNT
Plan Chk. Dep.
Minimum Setback Distances:
Plan Chk. Bal.
•
Const.
5901.
Mech.
53.50
Electrical
1730.741
•.. s•74 -
Plumbing
Plumbing
1230 '
S.M.I.
Grading
Driveway Enc.
_
Infrastructure
•
•.t
Validated by:
Validation:
ell[
TOTAL
REMARKS
:t1,'ixf ' r ici ?"dA!a7r"•a'y;-Acs , s nun rt [t
ZONE:
BY:
Minimum Setback Distances:
Front Setback f
om Center Line •
Rear Setback f
m Rear Prop. Line
Side Street Se ack from Center Line
Si a Setback f om. Property Line
d INSPECTOR
FINAL DATE
6-25-89
Issued by:Date
Permit
•.t
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE [ / ((
UGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. 0
1 IPOWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT.
GAS (FINAL) /p Q0
TEMP. POLE
WALL SO. FT.
DRINKING FOUNTAIN.
FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING % tJ Q1 D
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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 [ / ((
UGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. 1 -eoiq
GAS (ROUGH) ,/ /Z®
OP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) /p Q0
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING !0 0 _
FINAL INSP.
ROOFING % tJ Q1 D
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING /J (Q/
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL