05120 (MFD5)T4hf 4 4 a"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address LA QUINTA. CALIFORNIA 92253
Owner
Address 777 S. Main SC., Suite 106
City Zip Tel.
Orause 92686 714-54788056
Contractor
Sake A
State Lic. .� I City
& Classif. 3 1 Lic. # 7 7
Arch., Engr.,
Designer
Address Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S 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 in full force and
effect, x
SIGNATURE - DATE
OWNEWBUILDER DECLARATION
I hereby affirin that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5.Bushoss and Professions Code: Any city or county which requires a
permit to construct, alter. lrrprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to fie 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 Cade, or that. he is exempt therefrom, and the basis
for the alleged exermphon. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a cW penally of not more than five hundred dollars (E500).
❑ 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, Suisness and
Professions Code: The Conhactors 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 wi/vn one year of completion, the owner -budder will have the burden
or proving flat he did not bid or irpmve for the purpose of sale.)
❑ 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 bwMs or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License taw.)
❑ 1 am exempt under Sec n, & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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 furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be corrpleted ff 0re pemut is for one hundred dollars (S100) 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: ®, after making this Certificate of Exemption you should become
subject to the t#brkers' Conpeesatien provisions of the Labor Code, you must forthwith
comply with such provk*= or tivs perm 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, Civil Code.)
Lenders Name
Lenders Address
This is a building permit when property 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. 45120
LDING: TYPE CONST.OCC: GRP.:
Number 6I3-790"011
Legal Description
Project Description Building 36, Plan 2L: LOt 352
Sq. Ft. 912 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $65,225
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
.�' 275.61
Const.
33 00
Mech.
36.00
Electrical
AA.7A
Plumbing
7s.on
S.M.I.
b
Grading
Driveway Enc.
Infrastructure
1 w 467.57
?r1nvP—TaPd T. jpjqrA
TOTAL t? . 172 . 7
REMARKS
y
r d 2,,Cl:i i �l_'I(}_i}{�.. 4 c.
1lT - l.rla tY t ta.ti
ril 27r7. 1 s
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%28/88
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
SLAB GRADE ' / �5 CrD
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. g0, F7, ®
GAS (ROUGH)
METER LOOP
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP. SO. 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
ROOFING
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING -914V !'
MESH
INSULATIONISOUND-2
FINISH GRADING //;;
FINAL INSPECTION l L 6
CERT. OCC. c [[
ccurF FIIJAI
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, TEMIPERM
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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
TT
SETBACK
GROUND PLUMBING f
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ' / �5 CrD
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. JLr/'. /l
Z(/
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
00,
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. Ic 0 C
FRAMING 3 9 �6 FINAL INSP. 11 QD /
/( G
ROOFING
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING -914V !'
MESH
INSULATIONISOUND-2
FINISH GRADING //;;
FINAL INSPECTION l L 6
CERT. OCC. c [[
ccurF FIIJAI
-�
REMARKS:
SIGNATURESIINITIALS
GARDEN WALL FINAL