05221 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 71-Q15e. xmrsr# LA QUINTA, CALIFORNIA 92253
Owner
Mailing -
Address P. 4. Box 780
City Zip Tel.
La Quiii.ta 1 92253_ Sbb.—
Contractor
State Lic. City
& Classif. 378318 Lic. # 1.89
Arch., Engr.,
Designer
Address I Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
Ifl!I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
) of ivasion 3 of the Business and Professions Code, and my license is in full force and
effect _
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the following
reason_ (Sec- 7031.5,8usrrhess and Professions Code: Any city or county which requires a
permit to construct, afar, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Me 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 ad 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 civf penally of not more than rive 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 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. If, however, the building
or Improvement is sold within one year of completion, the owner -budder wig have the burden
of proving that he did net build or improve for the purpose of sale.)
p>l:`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 conbaaor(s) icensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Seri B. & P.C. for this reason
Date Owner t `
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.)
PolicyNo Company
. ❑ Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
1 certify that in the performance of lhp 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: tl, after making this Certificate or Exemption you should became
subject to the Wbrkers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shad 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, Civil Code.)
Lenders Name
Lenders 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.
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 properly for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST
No.
OCC: GRP._
A.P.,Number
Legal Description
Project Description
8anta Rasta cove
Plant � 'dart IAAF 6-A
Sq. Ft. 2510
Size
No. No. DIN.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
r
Estimated Valuation
$179,534
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
rj. 3 1 . 44 r , J A?
Const.
633,¢8 -
Mech.
87.00
Electrical
93.35
Plumbing
135.00
S.M.I.
12.57
Grading
Driveway Enc.
Infrastructure
4,059.52
TOTAL
$5.531.88 -
-- a
REMARKS
n�afR-2 i�5 :RTS r14-nx-S2C if►
14) Lf1Jt
Uri
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
12/34/88
Issued by- Date 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
FOUND. REINF. j I 22�Q
vv
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
CARP. SO. FT. ®
WATER SYSTEM
GRADING
lopcu. yd.
$ plus x$
WALL SO. FT.
LUMBER GR, FINAL INSP. /7
, I
DRINKING FOUNTAIN.
SOFT ®
/J
O /G �ifJ (�✓�/�jf/
e
URINAL
ESTIMATED CONSTRUCTION VALUATION $
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
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 VA c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/aC
HOUSE SEWER
GAS PIPING
PERMIT FEE
IPERMIT 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
R UNO PLUMBIN �� 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. j I 22�Q
vv
GAS (ROUGH) `� 1 METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
lopcu. yd.
$ plus x$
=$
LUMBER GR, FINAL INSP. /7
, I
FRAMING /�j'L �Y FINAL INSP. /2 / 7
ROOFING 5*/r
VENTILATION VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND Cl(�ky
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FFNr:F FINAI
/J
O /G �ifJ (�✓�/�jf/
e
REMARKS:
SIGNATURESIINITIALS
GARDEN WALL FINAL