06061 (RPL)Tiot
P.O. BOX 1504 N o . 06061
Building 54-472 Tanglewood 78-105 CALLE ESTADO
Address LA QUINTA; CALIFORNIA 92253
Owner -
SiiSe ets. -
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 42-'600 mak, gt • VCA blest
A.P. Number
City Zip Tel.
Palm Desert 92264 568-'2828 Legal Description
Contractor Gni ftof Constrnetiort r ' Project Description Pool and era
Address
68-465 Parra Rd.
City Zip Tela
CAt City 92234 328-2681
State Lic- City
& Classif. C-53 275796 LiC. # `" 69 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demoliton ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensl'd)under provisions{of Chapter 9 (commencing with Section
7000) of bivision 3 of the -Business and Professions Code, and my,ljcense is in full force and
effect
_SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation e
I hereby affirm that 1 am exempt from the Contractor's License Law for the following 2Q yvtisr0.00
reason: (Sec. 7031.5,Busness and Professions Code: Any city or county which requires a
Permit to construct, ager, irprove, demolish, or repair any structure, prior to its Issuance also AMOUNT
requires Ore apptiant for such permit to file a signed statement that he is licensed pursuant to PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Aivisfon 3 of the t and Professions Code, or that. he is exempt therefrom, and the basis
f6r the alleged exemption. Any vitiation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civipemafty of not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 134.55
do the work, and the structure is not intended or offered for sale. (sec. 7044, Buisness and Const. 207-00
Professions Code: The Contradoes 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, Mech. 27.00
7 pfd
provided that such improvements are not intended or offered for sale. If, however, the building 2 ` • 0v
or improvements sold wftltim one year of completion, the owner -builder will have the burden Electrical LI� 00
of proving that he old not build or irprove for the purpose of sale.) r •
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 24.00struct the project (Sec. 7044,. Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 1.40
such projects wgh a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec_ R- 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy: ttie r f. (Sec 3800, Labor Code.)
Policy No Company r -
❑ Copy is filed with the city- ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS _4
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 thg 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 Califomia
Date Owner
N077CE TO APPLICANT: fl, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Conpensation provisions of the Labor Code, you must forthwith
comply wgh such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
1 hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Chir' Code.) Side Setback from Property Line
Lender's Name
Lenders Address
This is abuilding permit when property filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 160 days. 7-5-89
1 certify that 1 have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
OTHER APPJEQUIP.
R . STEEL
GAS
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SQ. FT. ®
BOND BEAM
WATER SYSTEM
URINAL
SQ. FT. @
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
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(AUTOXDISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
(SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
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 FEEPLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWOR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
R . STEEL
GAS
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
/
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
SPECTION v /
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL