06113 (RPL)4
P.O. BOX 1504 N o .
Building� WIC �� 7&105 CALLE ESTADO
�
Address � -LA QUINTA, CALIFORNIA 92253
Owner
Rupert Ysssayistt
Mailing BUILDING:JYPE CONST. OCC: GRP.
Address Sarna r A.P. Number. 769x-065-007
City lZip ITel.
.51van Pools
Address
68-300 P mon Road #tis
City Zip Tel.:
Cathedral City 92234 324-4460
State Lic.City
& Classif. 42.1014 Lic. # ' 249
Arch., Engr.,
Designer
Address I 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 thbr, mess and Professions Code, and my license is in full force and
effect. � h��_ fJ <�s
SlGNATURE .- ' } 41- ? DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13uskiess and Professions Code: Any city or county which requires a
permit to construct,. after, improve. demoffsh, or repair any structure, prior to its issuance also
requires the applicant for such pema7 to Me a signed statement that he is licensed pursuant to
the provisions of the Contractors Liicense taw, 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 •ekenpSau. Any vision of Section 7031.5 by 'any applicant for a permit
subjects the applicant fi a chd penaQy of not more than live hundred dollars ($500).
❑ 1, as owne`r'of.theproperty, 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 Contractors License Law does not apply to an owner of property who
builds or improves thereon aid who does such work himself or through his own employees,
Provided that -such irprovements are not intended or offered for sale. If, however, the building
or improvement is sold wi7hh one year of completion, the owner -builder will have the burden
of proving that he did not brad or irprove 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 contracfar(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec a_ g 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be conflated B the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of UV work for which this permit is issued, I shall not
employ any ppeerson in airy manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: 8, .after making this Certificate of Exemption you should become
subject to the workers' Congmv;saffon provisions of the Labor Code, you must forthwith
comply with such provisions or this Permr7 stall 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, Cin? Code.)
Lenders Name
Lenders Address
This is abuilding permit when property 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
Legal Description
Project Description
061.13
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑. Alter ❑ Repair ❑ . "Demolition ❑
REMARKS ...c <rn ..:a int m•� r,� ra Awl ' tfS
J1;, t� Azfla .t t. _ ....3—yi4.tf�,
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Estimated Valuation 413,100
Side Setback from Property Line
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
d 99.45
Const.
153.00
Mech.
27.00
Electrical
34.00
Plumbing
24 X00
S.M.I.
l.€40
Grading
Driveway Enc.
Infrastructure
1$334.45
TOTAL
✓ ,,.-,,: `,r �.
REMARKS ...c <rn ..:a int m•� r,� ra Awl ' tfS
J1;, t� Azfla .t t. _ ....3—yi4.tf�,
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
7/25/89
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL SO. Ff.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. Fr. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3bc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBIN&a /
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
V3 7-4
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FI AL INSPECTIO 3 lt:y 1
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
MAILING ADDRESS P.O. BOX 1504 - LA QUINTA, CALIFORNIA 62253