06586 (SFD)T4'yl 4 4 Q"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 44-125 Caraten Place. LA QUINTA, CALIFORNIA 92253
Mailing
Address 74--923 Rowley 1130
City Zip Tel.
Palm Dsss t 02260 1 340-9174
Contractor
Same
State Lic.I City
& Classif. 50569 Lic. # 1
Designer I
Address Tel.
City Zip State
Lic. #
d j LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed:linder provisions of Chapter 9 (commencing with,Section
7(100) of Divisioon 3 of the _Busine/s/ss/�nydjprofessions Code, and my,,license }'s irr'f II farce and
effect. l ` t i C.N % /7
l l
SIGNATURE i A `- 8 DATE
'LOWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 the 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 cid penalty of not more than five hundred dollars ($500).
❑ 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, Buisness and
Professions Code: The Contractors 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. ff, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not bwld or krprove for the purpose of safe.)
O 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.)
❑ I am exempt under Sec 8. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, ora 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 completed it 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 shag 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, Ciel Code.)
Lenders Name
Lenders 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 certify that I have read this application and state that the above information is correct.
1 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.
BUILDING: TYPE CONST. OCC: GRP,
P. Number La Quinti 8iahlands Y2 23269
Legal Description
Project Description Plan D. Lot 14
Sq. Ft. 1813
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$100,293
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 535.34
Const.
643.00
Mech.
60.00
Electrical
109.84
Plumbing
132.50
S.M.I.
%.07
Grading
Driveway Enc.
Infrastructure
2,256.59
TOTAL
S3.744.34 .'".7V
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
10/25/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
$
UNITS
SLAB GRADE(( ( (
IST FL. SO. FT. ®
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
DUCT WORK
ROCK STORAGE
FOUND. REINF. t'
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. ®
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) 3 b/j %
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GROUT 1
WATER HEATER
SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SQ. FT. ®
WATER SYSTEM
WALL SQ. FT. ®
-
DRINKING FOUNTAIN.
FINAL INSP.
FRAMING Z ��/
URINAL
SO. FT. ®
n
/ / Zig /
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
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
FINISH GRADING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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
GROUND PL MBING
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. t'
6�16AS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) 3 b/j %
TEMP. POLE
GROUT 1
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
plus x$
-$
LUMBER GR.
FINAL INSP.
FRAMING Z ��/
�v
FINAL INSP.ot`It
12 v
ROOFING
n
/ / Zig /
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
'/
LATHING v l 70
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL