05750 (SFD)Building
Owner
La
c&t,, 4
P.O. BOX 1504
78-105 CALLE ESTADO
Ldp LA QUINTA, CALIFORNIA 92253
Y�intr Vas,.trasrn
Address P. 0. S= 7136'
City Zip 1. Tel.
La Ouiata 1 92253 1 _ 564-1315
Tela
State Lic. I City w
& Classif. 378318 Lic. # 189
Designer
Address Tel.
City I
Zip ' IState
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
700tH of Division 3 of the Business and Professions Code, and my license!p 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,Busfness and Professions Code: Any city or county which requires a
Permit to construct, after, improve, demolish, or repair any structure, prior to Us issuance also
requires the applicant for such permit to file a signed statement that hes licensed pursuant to
Me 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).
❑ 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 notapplyto an owner of properly who
drills or knproves thereon and who does such work himself or through his own employees,
provided that such improvements are not Intended or offered for sale. d, however, the building
orimprovement 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.) ..,.
O [,as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who bolds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .w
O 1 am exempt under Sec B. & 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. ❑ Certtfied copy is hereby furnished.
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.)
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
alifornia.DateOwner
NOTICE TO APPLICANT: N, after making this Certificate or Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code• you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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
No. 05750
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number Santa Rona Cove
Legal Description Lot 27
Project Description Plan Ss ' Tact 23813
REMARKS .•r-.�-`, ..r •:•� s.eY -., 6fr
.. wi.ty►7:WY' }..y.Yl r•Fr tr -�-.'..... .w. .� -
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
1
FINAL DATE INSPECTOR
Issued by: Date 5/15/89 Permit
Validated by:
Validation:
Sq. Ft. 3130
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$216,509
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ $59.25
Const.
1,049.00
Mech.
84.00
Electrical
150.35
Plumbing
202.50
S.M.I.
15.19
Grading
Driveway Enc.
Infrastructure
-
4,671.46
TOTAL
/",`L .
rte /. X.
REMARKS .•r-.�-`, ..r •:•� s.eY -., 6fr
.. wi.ty►7:WY' }..y.Yl r•Fr tr -�-.'..... .w. .� -
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
1
FINAL DATE INSPECTOR
Issued by: Date 5/15/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT, ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SO. FT.
DUCT WORK
ROCK STORAGE
2�
FOUND. REINF, ll6f�AS
MOBILEHOME SVC.
BAR SINK
POR SO FT ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. I SO. FT,
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
WALL SO. FT.
LUMBER GR.
DRINKING FOUNTAIN
FRAMING �� �S %
FINAL INSP.
URINAL
SO FT ®
REMARKS:
ESTIMATED CONSTRUCTION VALUATION $
VENTILATION
WATER PIPING
NOTE: Not to be used as property tax valuation
FIRE ZONE ROOFING
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
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
FINAL INSPECTION
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 V. c
SEWAGE DISPOSAL
FENCE FINAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
INSPECTOR'S SIGNATURES/INITIALS
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
yA� ��
SETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE (6 ��
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
2�
FOUND. REINF, ll6f�AS
(ROUGH) 2� p METER LOOP
I
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. b/
FRAMING �� �S %
FINAL INSP.
OFING`p^/r/�
PlIVIV
12-/��FIREPLACE (/,Y/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL