06381 (SFD)P.O. BOX 1504 N o . 06381
Building 5A-539 � Creek 7&105 CALLE ESTADO
AddressLA QUINTA, CALIFORNIA 92253
Owner � r
Si?S ise i�!)�RiZi�1'
Mailing
Address 75--W5 Co t> tt Club
City Zip Tel
Palm Desert. 92260 568--1828.
Contractor
- Same
Address
City
State Lic. 288130 ( City 328
& Classif. Lic. #
Arch.; Engr.,
Designer
Address Tel.
City I
Zip I State
Lic. #
f . LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
,TOf10)°of Division 3 of the Business and, Professions Code, and my license is in full force and
effect ts� s r• l r ,i: s ✓ , }r
SIGNATURE a ' ' r -:J X DATE
' OWNER•BUILOER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buskiess and Professions Code: Any city or county which requires a
pemrif to construct, after; krprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
ONWan 3 of the Busfaess 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 ave penally of not more than five hundred dollars ($500).
❑ 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. 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 improve 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 builds or improves thereon, and who contracts for
such projects with a confractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec 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
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
(Acis section need not be completed ff 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: !f, 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
1 hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is -issued. (Sec. 3097, CWI Code.) '
Lender's Name
Lender's 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 certity that I have read this application and state that the above information is correct.
Fagree 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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PGA Went Pane 21A
Legal Description
Project Description
Tract 28717-3, Plan 4CR
REMARKS
4' t x4 �+ {tc °Y. ,P(,ftia"CY +a 1 { !, art? xil
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
9120/89
Issued by: Date Permit
Validated by:
Validation:
Sq' Ft. 1918 -
Size
No`
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ DemolZion ❑
Estimated Valuation
$132*816
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
564.26
Const.
755.00-
55.00Mech.
Mech.
.W -
Electrical
112.04
Plumbing
1:31.00
S.M.I.
9.3
Grading
Driveway Enc.
Infrastructure
$2,988.36
1,494-18
sus C"it
1,494.113
TOTAL
,3 .l9
`'yx 11; �/
REMARKS
4' t x4 �+ {tc °Y. ,P(,ftia"CY +a 1 { !, art? xil
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
9120/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
B GRADE `
YARD SPKLR SYSTEM
2ND FL SO. FT.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ER OR SEPTI /
ROUGH WIRING
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
^•
S (ROUGH) _[ /,Y�
ZZZZCC
METER LOOP
DRAINAGE PIPING
CAR P. SO. FT. ®
. REINF. STEE
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN
WALL SQ. FT. ®
GROUT
WATER HEATER
URINAL
SO FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
91t,�
Gt/.`✓
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
MESH MESH
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
S BACK
ROUND PLUMBING
-1113' DERGROUND
A.C. UNIT
COLL. AREA
B GRADE `
/
ROUGH PLUMB.
i
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
+
ER OR SEPTI /
ROUGH WIRING
DUCT WORK
ROCK STORAGE
UND. REINF. 1
^•
S (ROUGH) _[ /,Y�
ZZZZCC
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
. REINF. STEE
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
INAL INSP904�j
FRAMING / _
FINAL INSP.
ROOFING
91t,�
Gt/.`✓
r— 1 �(�
`
♦rv�
REMARKS
VENTILATION`
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
!,,// THING �� 'eel
MESH MESH
INSULATIONISOUN —
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t