06641 (SFD)bf 4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address ^ 53—'9W Velaaw LA QUINTA, CALIFORNIA 92253
Owner
Address 510 Flower Hin 1,a
CityZip Tel.
Palm Desert 9226#1 I 7i3t9,0 , _
Contractor
Jack. Clark Jr.
Address
City Zip Tela
La eta 92253 564.3511
State Lic. , City
& Classif. S� t6 7 Lic. # Sq][New
Ft
Arch., Engr.,
Designer
Address I Tel.
No. 06641
BUILDING: TYPE CONST: OCC: GRP.
A:P. Number - - - - 774-165--010 -
Legal Description
SFD
Project Description
CityI Zip I State
Lic. #
y LICENSED CONTRACTOR'S DECLARATION .
I hereby affirm thatJ, am licensed under provisions of Chapter 9 (commencing with
7000) of Divisiiron 3 of+Ithe Business and Professiohs Code, and my license is iri.full h
effect. `1; 1 f � � f � Cg `7 /f( 4ir�
r c
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiress and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
• requires the applicant for such permit to life 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 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 applicant to a civil penalty of not more than five hundred dollars (E500).
O 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, Buisness and
Professions Code: The Contractor's 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. ff. 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 improve 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 of property who bins or improves thereon, and who contracts for
such projects with a contractor(s) ficensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec_ a, & P.C. for this reason
Date Owner
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 thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 perfomrance of the work for which this permit is issued, I shall not
employany person in any manner so as to become subject to the Workers' Compensation
Laws"of California
Date` r ` � Owner :i _x,—; k cd :'•' '�� , �.
NOTICE TO APPLICANT: ff, after mabV 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 shag 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 r i_ "' r .--i f f lam` •° rti
Lender's Address f' ' " 1 % r •°' ��
This is a building permit when property filled but, 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 r
City, State, Zip : r �• 4 �•
1635 No. No. Dw.
Stories ` Units -
Add ❑ Alter ❑ Repair ❑ Demolition ❑
tstfmatea valuation
Qoti _ 742
PERMIT
AMOUNT
Plan Chk. Dep.
$250.00
Plan Chk. Bal.
29.56
Const.
"~ 599.00
Mech.
53-50-
3. 0Electrical
Electrical
U4. 12
Plumbing
157.50
S. M.I.
6..37
Grading
20400
Driveway Enc.
20.00
Infrastructure
1093.
TOTAL
.$3,473..39
REMARKS
1
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
11/13/89
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE O
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
/Jj�
/ SEPTIC TANFS,��' ROUGH WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
METER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GROUT
WATER HEATER
DRAINAGE PIPING
CAR P. SO. FT. ®
BOND BEAM
WALL SQ. FT.
FINAL INSP.
$
DRINKING FOUNTAIN.
LUMBER GR.
URINAL
SO FT ®
^`/ �
;A / �
S G
l� )
1
v
O
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
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
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
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
FINISH GRADING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 V c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
NECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK /
ROUND PLUMBING
29 UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE O
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
/Jj�
/ SEPTIC TANFS,��' ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. 90 /l/j /,
w
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
$
GRADING
cu. yd.
-Plus-X$-=$
LUMBER GR.
FRAMING
ROOFING fjUj. �/y�//(gyp
^`/ �
;A / �
S G
l� )
1
v
O
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING.¢nlvN 1// I - e
MESH
INSULATIONISOUND 90
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
I