05039 (SFD)uujttcv
P.O. BOX 1504
Building 36-599 Shoal Creek LA QUINTA8-105 C
Address CAL FORNIA 92253
Owner
Sua�3se CO;a,pa32y
Mailing
Address 42_600 Cook Street. STs a 200
City Zip Tel.
pa 1 n AvArr 1 _92260 1 1 -SAA-292R
Contractor
ress
Tel:
State Lic. I City
& Classif. 288130 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
City I
Zip I
State
Lic. #
LICENSED CONTRACTOWS 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 Cade, and my license is in full force and
' effect.
SIGNATURE DATE
OWNMOUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness and Processions Code: Any city or county which requires a
permit to construct, atter, Improve, dernofsh, or repair any structure, prior to its issuance also
requires the applicant for such permit to lite a signed statement that he is licensed pursuant to
the provisions of the Contractors 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 civilpenally 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 safe. ff, however, the building
or improvement is sold within one year of completion, the owner-bwlder will have the burden
of proving that he did not build or krprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct
onstruct the project. (Sec. 7044, Business and Professions Code. The Contractor's License Law
does not apply to an owner of property who bwlds or inproves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec_ a. S 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 -
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF E%EMPTION 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 thg 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: If, after maAig 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, Civif 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 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 4
Pity, State, Zip 1
I
No. 05039_
c -
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PrA %TAnt — Pbat:an 19A
Legal Description
Project Description P1 '"W1 '4(111
Sq. Ft. 1627 No. No. Dw.
Size Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolit'on ❑
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
12/23/88
Issued by:
Estimated Valuation
$11.3,727
PERMIT
Validation:
AMOUNT
Plan Chk. Dep.
I
Plan Chk. Bal.
8
3.80.44
Const.
468.00
Mech.
34.00
Electrical
S 7 4 ;m
Plumbing
87.50
S.M.I.
7.95
Grading
Driveway Enc.
Infrastructure
, 2 ,�88 . 86
1 «279.43
F r1.279.43
TOTAL
97.324.73
7 . 7,L} -7
REMARKS
�.
_ W 1Pf P17'1.... �t^"..1fA^fif'i.
x{.: r✓:�r'S �t Y, I �}19'x%.
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
12/23/88
Issued by:
Date Permit
.Validated by:
Validation:
I
14 -co ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
R%UPM PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. • SQ. FT.
FORMS
ER OR STR IC NK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
P61A. SQ Fr. ®
G (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL SQ. FT. ®
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
Cu. yd.
$ plus x$
=$
URINAL
SO. FT. ®
i
`/qAMING
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
`
�4
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDiSH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ILAUNDRYTRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
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
SULATION/SOUND 7
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% 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 ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
R%UPM PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR STR IC NK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. do
G (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
AS (FINAL) Z
TEMP. POLE
GROUT
WATER HEATER
VICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
=$
UMBER GR.
FINAL INSP.
i
`/qAMING
FINAL INSP.
FING `
`
�4
(O Gfs
�i��VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
SULATION/SOUND 7
"SH GRADING
INAL INSPECTION 7
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIAIS
GARDEN WALL FINAL
t