05754 (SFD)4
P.O. BOX 1504 No. 05754
Building78-105 76 950 Fernando LA.QUINTACCAL FORNIA 92253
AddrPcc -
Owner
La
Mailing
Address P.
City
La quinta
Cnntrartor
Joint Venture
780 ~
Zip Tt
92253
Barrila Construction
1. 564-'1315
Tel:
State Lic. I City
& Classif- , 378318 Lic. # 189 _
Arch., Engr-,
Designer
Address Tel.
City (Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirmthat I am licensed under provisions of Chapter 9 (commencing with Section
of D ision 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- 7031.5,13usiness and Professions Code: Any city or county which requires a
permit to construct, agar. improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to We a signed statement that he is licensed pursuant to
the provisions of the Contractors 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 SIe�ch�h
t�ion 7031.5 by 'any applicant for a permit
subjects the appicant to a chd penally of not more S five hundred dollars ($500). -
❑ 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. O, however, the building
or improvement is said within one year of completion, the owner -builder wig have the burden
of proving that he did not build or improve for the purpose of safe.) '-
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 of improves thereon, and who contracts for
such projects with a conbactor(s) 8censed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec B. 8, 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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No
Company�''�
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
1 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 Ca ifomia
Date Owner
NOTICE TO APPLICANT. it. after making this Certificate of Exemption you should become
subject to the workers' Cmpensation provisions of 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, CM 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 certity 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: GRP.;
A.P. Number Santa Rosa Cove
Legal Description
Project Description
Lot 18
Pith A,
Treet 23813
Sq. Ft. 3229
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$258,544
/
PERMIT
AMOUNT
Plan Chk. Dep.
Plan,Chk. Bal.
9 •
Const.
s •QQ
Mech.
90.Uo
Electrical
70
Plumbing _
191..0
18.13
Grading
Driveway Enc.
Infrastructure
s8 •
TOTAL
s 5 •
`r :/ ` 1 I //`
REMARKS
'Cf I r__ dr'- �rrv.:.a • i v • •,
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
:Side Street Setback from Center Line
Side Setback from Property Line
FINAL -DATE INSPECTOR
Issued by: Date 5115/89 Permit
Validated by:
Validation:
NO. ELECTRICAL FEES
NO. PLUMBING FEES
UNITS
UNDERGROUND
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
BONDING
DRAINAGE PIPING
«
DRINKING FOUNTAIN
FORMS
URINAL
WATER PIPING
FLOOR DRAIN
ROCK STORAGE
WATER SOFTENER
SIGN
WASHER(AUTO)(DISH)
METER LOOP
GARBAGE DISPOSAL
HEATING (FINAL)
LAUNDRY TRAY
REIN F. STEEL
KITCHEN SINK
TEMP USE PERMIT SVC
WATER CLOSET'
POLE, TEM/PERM
LAVATORY
AMPERES SERV ENT
SHOWER
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
GAS PIPING
GRADING
cu. yd.
plus x$
PERMIT FEE
PERMIT FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE Z
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND-REINF,.. -(.z
` GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP. 3 � oQ
FRAMAG Q /
FINAL INSP.
NG
/,/�'/J�
/ c/�
L���l
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING G
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL