06664 (SFD)4
P.O. BOX 1504 No.
Building 78-105 CALLE ESTADO
Address 78-820 Sone$La Way LA QUINTA, CALIFORNIA 92253
Owner
Mailing "
Address "23 Hovlay #130
Cityip Tel.
..Palsy �IwTrtz
922£0 340--9174,
Contractor
Sim
Address
City lZip I Tel.
State Lic_ City
& Classif_ 545699 Lic. # 13.83.,
Arch., Engr_,
Designer
AddressTel.
City(Zip I State
Lic. #
—,� LICENSED CONTRACTOR'S DECLARATION
I hereby alfirm,Drdt I am licensed undAr Drovisions of Chapter 9 (commencing with Section
7= Divisr 3 of the BusihdWand Professions Code, and my license is in full force and
SIGNATURE DATE
OWNkWBUILDER DECLARATION '
I hereby affirfn that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.S,Llusihess and Professions Code: Any city or county which requires a
Permit to construct. alter, irprove, demolislh. or repair any structure, prior to its issuance also
requires the applicant for such Permed 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
ONision 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 appirart to a civil penaLfy of not more than Trve 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
bmlds or improves thereon and who does such work himself or through his ownemployees,
provided that such irprovements are not intended or offered for sale. t, however, the building
or erprovement is sold within one year of completion, the owner -builder will have the burden
of proving that he dd not build or ihprove for the purpose o1 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 Contractors License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) icensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sea B. & 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Potiq No Company
El 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 the permit is for one hundred dollars (8100) valuation
or less.) .
I certify that in the performance of the work for which this permit is issued, 1 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: t, after making this Certificate of Exemption you should become
subject to fie YYbrkers' Corrpensaton provisions of the Labor Code, you must forthwith
campy 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
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 read 1 have rthis 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.
constructior% and (hereby authorize representatives -of this city to enter the -above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zi
06664
BUILDI NG: _ TYPE CONST. OCC: GRP.
A:P: NumberLa QULUXa F19$ 8 TT 23269
Legal Description
Project Description $FD PUD C—R Lot 2$
Sq. Ft. 1563 �. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 489.07
Const...
585.50
Mech.
60.00
Electrical
101.21
Plumbing
120.50
S.M.I.
6.16
Grading
Driveway Enc.
Infrastructure
1,970.80
TOTALS
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
Issued by: Date 11117/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE 1
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. Q
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
S (ROUGH) (/� If n�Q
C
ETER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. a
FINAL INSP.
WALL SO. FT. @
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
-$
URINAL
SO FT ®
FRAMING 01 `�
FINAL INSPy ��
CC
ESTIMATED CONSTRUCTION VALUATION $
�/�^ / O
;�j /✓ (Q
, f
(/
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:lC(
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® Vic
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 1
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. (
S (ROUGH) (/� If n�Q
C
ETER LOOP
HEATING (FINAL)
OTHER APPIEOUIP.
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 (✓ q(
FRAMING 01 `�
FINAL INSPy ��
CC
ROOFING 9-/(1/
�/�^ / O
;�j /✓ (Q
, f
(/
� u � J��
QCT
REMARKS:lC(
�
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
' MESH
INSULATIONISOUND
FINISH GRADING
/
FINAL INSPECTION (/ At; je
111
CERT. OCC.
J FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
w..
GARDEN WALL FINAL