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06420 (SFD)4 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 54-636 Shoal Creak LA QUINTA, CALIFORNIA 92253 Owner Mailing ' Address T ¢ City Zip Tel. . Palm Desert 92264 $68.2828 Contractor NatLonal Lsad 6 Mortgage Address /e5lq q - No. 06420 BUILDING: -TYPE CONST. OCC: GRP... A.P. Number West Pbass 18A Legal Description Project Description TrAict 20717-3, Plan. 3M �.rty up f ei. State Lic. 2$1319 City 32$ M 1627 & Classif. Lic. # Sq. Ft. No. No.,Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolit©n ❑ Address Tel. City Zip State s Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that.l am licensed under provisions of Chapter 9 (commencing with Section 7000)"of Division 3 of the Busirressrand Professions Code, and my license isin full:f and effect_ t t , +. -ter �... '1 3. i',. Y t .._ .•( O� k r. - u , SIGNATURE — r t %' W ?DATE OWNEIMMILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,13rmness and Professions Lode: 'Any city or county which requires a permit to construct, alter, inprove, demolish. or repair any structure, prior to its issuance also requires the appicad for such Penni to file a signed statement that he is licensed pursuant to the provisions of the Carmactael; License taw, Chapter 9 (commencing with Section 7000) of Division 3 or the Business and Processions Code, or that. he is exempt therefrom, and the basis for the alleged exerrption_ Any violation or Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penally of not more flan 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 Contractors License Law does not apply to an owner of property who builds or improves thereon and ala does such work hinself or through his own employees, provided that such iipmvernerds are not Wended or offered for sale. If, however, the building orimprovement is sold within ane year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sate.) ❑ 1, as owner of the properly, am exclusively contracting with licensed contractors to corF struct the project (Sec- 7044, Busrress and Professions Code: The Contractor's License Law does not appy to an owner of property who builds or improves thereon, and who contracts for such projects with a cardradav(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec R_ & 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 (This section new 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: 9, alter making this Certificate of Exemption you should become subject to the YYbrkers' Compensation provisions of the Labor Code, you must forthwith comply with such Provisions or this pend 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 Lenders 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 City, State, Zip' 3timated Valuation $111,727 Minimum Setback Distances: PERMIT Front Setback.from Center Line AMOUNT Plan Chk. Dep. Side Street Setback from Center Line Plan Chk. Bal. Side Setback from Property Line 563.08 Const. INSPECTOR 688.50 Mech. Issued by: 51,.00 Electrical 101.12 Plumbing 131.00 S.M.I. 7.98 Grading Driveway Enc. Infrastructure $2,558.86 2,279.43 T"s Credit •1,279:.43 TOTAL $2,822.09 1__9 ;fes REMARKS a Ova 1 relkWl v 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 9/28/89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE �!/7-10 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 UND. REINF. r' POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® HEATING (FINAL) OTHER APPJEQUIP. REINF. STEE GAS (FINAL) DRAINAGE PIPING CAR P. SO. FT. ® GROUT WATER HEATER DRINKING FOUNTAIN WALL SQ. FT. FINAL INSP. BOND BEAM WATER SYSTEM URINAL SQ. FT. GRADING cu. yd. plus x$ _$ ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation ROOFING 12 _11r FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM 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 SQ. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1 Vi 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 COND. SOLAR ,fTBACK ROUND PLUMBING ( UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE �!/7-10 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS �, ER OR SEPTI ROUGH WIRING DUCT WORK ROCK STORAGE UND. REINF. r' GAS (ROUGH) 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./ FINAL INSP. MING �� U FINAL INSP. ROOFING 12 _11r / ^ 2 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH _JJI(LNSULATIONISOUND _ FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL