06377 (SFD)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54--551 SliIn/c,1 CrPPA LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address n—cloS Comtry Club
City lZip ITel.
Contractor
Address
Tel.-
State
ela
State Lic. City
& Classif. 288130 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
City( Zip (State
Lic. #
/ LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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:: {
SIGNATUREf' t ,/"h„/ DATE
1 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 Canty which requkes a
permit to construct, after, improve, demafsh. or repab any struoNe, prior to its Issuance also
requires the applicant for such permit to ft a sorted slateroent that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 Nornmeucrrg with Section 7000) of
Division 3 of the Business and Professions Code. or that. he is exempt thenthom, and the basis
for the alleged exemption. Any violation of Sewn 7031.5 by 'any appEca t for a permit
subjects the applicant to a civff penalty of not more than five hundred dollars (5500)_
❑ 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, Busness 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 notintended or offered for safe_ ff, however, the buildingor improvement is sold within one year of completion. the owner-6uiaer Will have the burden
of proving that he did not build or improve for the purpose of safe.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con
struct the project. (Sec. 7044, Business -and Professions Code. The Cordractoes License Law
does not apply to an owner of property who bolds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Cantractors License Law.)
❑ 1 am exempt under Sec_ a_ & P.C_ for this reason
Date Owner
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_ 3600. Labor Code.)
Policy No Company
❑ Copy is filed with.the city. . ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the peed is for one hundred doffms (5100) valation
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
bate Owner
NOTICE TO APPLICANT: If, after making the CeRBcate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Cody you most forthwith
comply with such provisions or this peed 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 t 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
City,. State, Zip
No. 06377
BUILDING: TYPE CONST. OCC: GRP.
A.P.. Number FGA UP -at .. a 21A
Legal Description
Project Description `tract 20717-3. Plan 3&
REMARKS _ W
Aty ai' .l ;q5 (It� r,
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
9/20/89
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft. 1627 �
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demoli:ion ❑
Estimated Valuation
$113,727
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. _Bal.
%3.06
Const.
688.50
Mech.
51.00
Electrical
101.12
Plumbing
131.00
S.M.I.
7.98
Grading
Driveway Enc.
21
Infrastructure
$,2,558,86
gs._a�Q.
'Less Credit
1,299.43
TOTAL
$2.822.09
REMARKS _ W
Aty ai' .l ;q5 (It� r,
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
9/20/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES '
1ST FL. SQ. FT. ® $
UNITS
COLL, AREA
B GRADE G
It
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
\\
F EINE .n
VV
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
INF. STEE
GAS (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SQ. FT. @
GRADING
cu. yd.
$ plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
? G�
O K6j&
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
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.
SQ. 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/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE AELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACKD
PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
B GRADE G
It
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SEPTIC ~ K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
\\
F EINE .n
VV
AS (ROUGH.
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
INF. STEE
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.INAL
INSP. 3
RAMING
FINAL INSP.
? G�
O K6j&
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
FIREWALL
``GAR.
CATHING 2 -!?*j'
MESH
NSULATION/SOUND -(2 -j
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL