06681 (BLCK)Building
Address 51-485 VeLmCB
Owner
Mailing
Address Sets
City Zip
.. La QuInt a 92253
Contractor
T+ -Saone M�aisv
Address
52-637 Villa
City Zip
La Q"Uta 92253
State Lic.
& Classif. 434257
Arch En r • '
Tit, -
4-
P.O. BOX 1504 No. 016681
78-105 CALLE ESTADO
_LA,QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
773--985-024
Tel. -
Legal Description
Project Description 1251 Barden =all 6• hi
E•�
Lic. #
Sq. Ft.
Size
No. No. Dw.
Stories Units
Designerg
New ❑ Add ❑ ' Alter ❑
Repair ❑. Demolition ❑
Address'
Tel.
City
Zip
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. y
SIGNATURE DATE
- ~ OWNER -BUILDER DECLARATION '
I. hereby affirm that I am exempt from the Contractor's License Law for the following..
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demorlsh, or repair any structure, prior to its issuance also
requires the applicant for such permit to Iffe a signed statement that he is licensed pursuant to
. ,^the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
�' Division 3 o 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 _applicant to a civil penalty of not more than Ove hundred dollars ($500).
0.1, as owner'of the property, or my employees with wages as their sole compensation, will
'clothe work, and the structure is not intended or offered for sale. (Sec. 7044, Suisness and
••-`Professions, Code: The Contractor's License Law does not apply to an owner of property who
.builds -or improves thereon andwhodoes 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 -builder will have the burden
of proving that he did not build or.anprove for the purpose of sale.) .. ..
O 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 or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Estimated Valuation ¢
$3,125
kti
PERMIT - -
-
AMOUNT -
Plan Chk. Dep.
- {
Plan Chk. Bal.
Const. -
$5� •
Mech. ..
Electrical
Plumbing s
,
S.M.I, 1:
���
Grading
Driveway Enc.
Date Owner
Infrastructure
`
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
- O Copy is filed with the city. ❑ Certified copy is hereby furnished.
.
\ `•y .. \
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit 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
NOTICE •TO APPLICANT: ff, after making 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 this permit 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.)
Lender's Name
Lender's 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 agiee 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
i
REMARKS x�.'.i:''i1.:?;?"}�•'�1,.f1.;_;�(3 ,
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 DATEINSPECTOR ')
11/21/89
Issued by: ' ,' 'i Date Permit r
Validated by: `
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. Sp_ FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL Sp. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
Sp. FT. @
FINAL INSP
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
n
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(AUTOHDISH)
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 ® 1V4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
FINAL INSPECTION
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
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
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
FRAMING
FINAL INSP.
n
ROOFING
V
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1