05204 (SFD)Building
Address
{iia Fernando
AV
P.O: BOX 1504 No. 05204
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address P. 0. Box 780 —
City Zip Tel.
L8 Qain ;>a 92253 564--1315
Contractor
$aarrila Const.
Address
q07 Yl
State Lic. ki City
& Classif. 378318 c. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTORS 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
effect. in full force and
f Jam. �
SIGNATURE pATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,13usi ness 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 lie a signed statement that he is licensed pursuant to
the provisions o1 the ConbaUw'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 bass
for the alf ged exertption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a cine penalty of not more Man five hundred doltars ($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, Busness and
Ij 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 rmprovemerds are not intended or offered for safe. H,, however. the building
or improvement is sold within one year of completion, the owner-buider will have the burden
of proving that he did not build or irprove for the purpose of sale.)
.131, 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 builds or improves thereon. and who contracts for
such projects with a contrdc(Ws) licensed pursuant to the Contractors license Law.)
t❑ 1 am exempt under Sec --------B. & P.C- for this reason
Dater 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
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 Ore pend 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 J
NOTICE TO APPLICANT: O, after mating 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 On pend shat 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
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description
�3
OCC. GRP.•
Sante Rosa Cove
Plan A — Tract 14496-4
Sq. Ft. 3720
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
S23fi 5II.4
PERMIT
AMOUNT
Plan Chk. Dep.
/-.5-5—
SPlan
PlanChk. Bal.
$ -44-1:15-
Const.
830.50
Mech.
ej . (m
Electrical
12A.91
Plumbing
127. p0
S.M.I.
in
Grading
Driveway Enc.
Infrastructure
5 B 17 24
`TOTAL
57.648.30
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
12/30/88
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE S �)
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. gp, FT. ®
S (ROUGH) ay l�
N
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. Q. FT. @
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
ING /
FLOOR DRAIN
MECHANICAL FEES
D L ' _
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
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 C
SEWAGE DISPOSAL
CATION/SOUND
SO.FT.GAR ® %c
HOUSE SEWER
INISH GRADING
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 PLUMING , ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE S �)
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.Vito <
S (ROUGH) ay l�
N
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. ��
ING /
//
FINAL INSP. �ZZ/y%�
O ING
D L ' _
� f�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR FIR�wEWALL
N(ito h461,2
M ES
CATION/SOUND
INISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL