06373 (SFD)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-563 Sal Creek LA QUINTA, CALIFORNIA 92253
Owner
$It urine -Cott anv
Address 775-005 001untty Club
City Zip ITel.
Contractor
No.
r3
06373
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PICA West -- Phase .21A
agal Description
roject Description __7'rsket 20717-3.. Plan 2C
City
Zip
TeL
State Lic. -
& Classif. 288130
City
Lic. # 328
Sq. Ft. 1548
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Address
Tel.
City
Zip
State
Lic: #
LICENSED CONTRACTOR'S DECLARATION
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.
SIGNATURE - DATE
OwNEWBUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
Estimated Valuation
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
permit to construct, after, unprove, demolish, or repair any structure, prior to its issuance also
. requires the applicant for such permit to file a signed statement that he is licensed pursuanrto
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 (S500).
❑ 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
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 knprovements are not intended or offered for sale. H however, the building
or improvement is sold within one year of completion, the owner- budder will have the burden
of proving that he did not build or improve for the purpose of sale.)
!
PERMIT
` AMOUNT '
Plan Chk. D`ep: '
Plan Chk. Bal.
�,$ 549.84
Const.
671.00Professions
Mech.
,d�
.vo
Electrical
9$..l.€i
s
131.00
❑ I, as owner of the property, am exclusively contracting with licensed contractors to coo -Plumbing
struct the project (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of 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. 8 P.C. for this reason
S.M.I.
•00
Grading
Driveway Enc.
Date owner
Infrastructure
A2,442,28 1,2.21.14
Teas Credit
1,221.14
WORKERS' COMPENSATION DECLARATION
I her affirm that 1 have a certificate of consent to self -'Insure, or a certificate of
Workers 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.
TOTAL
$2,729.77
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dogars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
REMARKS
ame,a_ ;,.} of 3Lltxil4a ��5-frit �(�
�q
O ~ ✓ n, f 4 1 U f AL - 'I f - - ( e a �
late Owner
NOTICE.TO APPLICANT. t, 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 Provsions or this pemtit shah be deemed revoked.
ZONE: - BY.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Cha code.)
Side Street Setback from Center Line
Side Setback from Property Line
Lenders Name
FINAL DATE
-INSPECTOR
�
/20/89
Lenders Address
This is abuilding permit when properly 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 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 inspect ton purposes.
Issued by:
Validated by:
Date Permit
j
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
/ B GRADE 1
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS G
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
UND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
STEELJV
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
WALL SQ. FT.
WATER HEATER
DRINKING FOUNTAIN
FINAL INSP.
URINAL
SOFT ®
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
$ plus xS
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP. --
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, TEMIPERM
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® Vic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
TOTAL FEES
MICRO FEE
MECH.FEEPL.CK.FEE
CONST. FEESMI
rECT_
FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
/ B GRADE 1
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS G
)"A -
ER OR SEPTIROUGH
WIRING
DUCT WORK
ROCK STORAGE
UND. REINF.
�AS (ROUGH) �f
v—
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
STEELJV
GAS (FINAL)
TEMP. POLE
rEINF.
ROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xS
=E
LUMBER GR.
FINAL INSP. --
FRANG
FINAL INSP.
76
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
&LATHING 2
/MESH
�ILJSULATION/SOUND
1A j
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL