SFD (09332)Building 53-900 AVENIDA MENDOZA
Address
Owner
ling
City I Zip ITel.
ntractor
Aaaress
5005 S" It"NARL 8-1
State Lic. I City
& Classif. 606486 Lic. #
Arch., Engr.,
Designer
Address —T—Te—1
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
F�
City Zip State
I I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm,that I am licensed under Provisions of Chapter 9 (commencing with Section
7DOO) of DI iness and Professions Code, and my license is in full force and
effec 3 of the Bus
—Z — DATEI
OWNER -BUILDER DECLARATION
I 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 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).
0 1, 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 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.)
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 improves thereon, and who contracts for
such projects with a contracfor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec._B. &.P.C. for this reason
Date—Owner
WORKERS' COMPENSATION DECLARATION
klehereby affirm that I have a certificate of consent to self -insure, or a certificate of
Wor r's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company —
0 Copy is filed with the city. 0 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 I work for which this permit is issued, I shall not
Jemploy anyiFerrson in any manner slo'as to become subject to the Workers' Compensation
Laws of Cal 0 a.
Date— lwner-
OTC
.A
A
If, aft
ANT. , ee. making�- this 'C6rtiljdiite of-Exiun kou'should'bdicohid,
subject to fh��' Workers' Compensation provisions of t i�rmust 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. 309 7, 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 it work thereunder is suspended for 180 days.
I car illy 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 Addres
City, State, Zip
No. 09332
BUILDING: TYPE CONST.—OCC. GRP.-
A.P. Number
Legal Description
Project Description SIED
Sq. Ft. 1450 No. No. Dw.
Size Ifte Stories Units
New 0 Add 0 Alter 0 Repair 0 Demolition 0
-a'A
Estimated Valuation
I
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S. M. 1.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
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 frEES
1ST FL. SO. FT. @ $
2ND FL. SO. FT. g
POR. SO. FT. @
'GAR. SO. FT. @
CAR P. I 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS(ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
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 @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERIM
:::� IT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE 1PL.CK.FEE
CONST. FEE ELECT.FEE
SMIFEE 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 APPJEQUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL I
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TiN of Ila (Quinta
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This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building!
Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 53-900 Avenida Mendoza
Use Classification SFD Bldg. Permit No. 09332
Group R3 Type Construction VN Fire Zone Use Zone SR
Owner of Building Landrace Cor oration Address 73625 Hwy 111 #G
City Palm Desert, CA 92260 By Mark Harold
Date; June 26, 1991
Building Official 610- POST IN A CONSVICUOUS PLACE
L !U
1141fism