9606 (ELEC)4-14
P.O. BOX 1504 N o .
Building79-439 Horizon Palms (C1t ^�7�����8-105CALLEESTADO
Address LA CtUINTA, CALIFORNIA 92253
Owner
R. Bugene Burke
Address same
City Zip Tel.
La Quint` 92:253 345--5467
Contractor
C•vmer a/fti lder
Address
Zip I Tel.:
State Lic. I City
& Classif.. Lic. #
Designer
Address Tel.
City (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) 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 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, alter, 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 - 7031.5by 'any applicant for a permit
sUpjects the applicant to a civil penalty of not more than five'hundred dollars ($500).
61,
as owner of the property, or my employees with wages as their sole compensation; will .
do the work, and the structure isnot 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 Lnproves 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: f B. & P.C. for this reason
Date Owner
ar
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
.. 0 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 performs ce of thg work ,ffor which this permit is issued, I shall not .
=any parson in any man r so a to bec6me subject to the Workers' Compe sation
Laws of California.
Data Owner e_1- iO.t. s �'�
NOTICE TO APPLICANT: 1.( a r making the Certificate o/ Exemption you should become
subject to 'the Workers''Compensation provisions 6% 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
BUILDING: TYPE CONST. OCC: GR.P.-
A.P. Number t/ . U(. / 5 M,4; -
Legal Description
Project Description Electric 031 above ground spa.
REMARKS
y2;
f"i�1%7.3•`tn<`i•�y5 � T➢ii�t�ti3.,�� �."P -" 9,9,. Vit# A4
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:
Sq. Ft.
Size
No. No. Dw.
Stories Units -
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const..
Mech.
Electrical
18.50
Plumbing
S.M.I.
Grading
Driveway Enc.
"
Infrastructure
,y.
TOTAL
33.50
REMARKS
y2;
f"i�1%7.3•`tn<`i•�y5 � T➢ii�t�ti3.,�� �."P -" 9,9,. Vit# A4
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
IST 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® IVs c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3yic
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEIE
I
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND t
V 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.�Z 3 r
FRAMING
FINAL INSP.
ROOFING
(4W W 0,l , 6L Ei-a
telx3 Otl L /1
— C, I l✓` v
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
1661 Z Z �dl
March 26, 1991
Architectural Committee
La Quinta Palms Owners Association
% Euclid Management
125 S. Mountain
Upland,'CA'91786
RE: Lot 29,
Dear Sirs,
Attached please find the proposed plan for the new portable spa at
79-439 Horizon Palms Circle.
Exhibit 1 indicates the area including 79-443 and 79-439 Horizon Palms Cir.
Exhibit 2 provides detail and elevation for the area
Exhibit 3 provides detail of fencing and sidewalk.
Should you have any questions, please contact me at:
PO Box 2704
Huntington Beach, CA 92647
(714) 842-5100
Very truly yours,
' ,� /j '��%� Yom. �.�_ '�'�•
R. Eugene Burke, Owner
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