06430 (SFD)Building
Address 54-684 Shoop Ore
Owner
Su=iee Dampany
Mailing
Address 42-600 Cook St,
City Zip
paitaDDeserti
92260
Address
0200
Tel.
scsi
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City Zip Tela
State Lic. City
& Classif. 288130 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
City FipStateI
Lic. #
J LICENSED CONTRACTOR'S 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 Code, and my license is:in full force and
effect• In / *2
SIGNATURE 1 r 0 f DATE
f I r OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5;8usiress and Professions Code:" Any city or county which requires a
Permit to construct, ager, improve, 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 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 cm7 penalty of not more than live hundred dollars ($500).
O 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 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 safe.)
O 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 contractor(s) licensed pursuant to the Contractor's License Law.)
O I•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
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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, 1 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: ff, 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
Ihereby 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 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.
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'
. P�fi 3_J
No. 06430
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PCA WEST Mose 18A
Legal Description
Project Description Tract .20711-3. Plan 4€I
Sq. Ft. 1918 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$132,816
PERMIT
BY:
AMOUNT
Plan Chk. Dep.
Front Setback from Center Line
Plan Chk. Bal.
$
564.26
Const.
Side Setback from Property Line
755..1m
Mech.
INSPECTOR
51.00
Electrical
Issued by:
112.04
Plumbing
131.00
S.M.I.
9.31
Grading
Driveway Enc.
Infrastructure
$2.988.36
1,494.48
testy Credit
1,494.18
TOTAL
53.116..79
t I r , ` /
ritMAHKJ nn .t stoma .rt J.SCz tJ kia. SMS
-,rat;
IrillJ� 2 " 5bxb:;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
9/28/89Permit
Issued by:
Date
Validated by:
Validation:
CONSTRUCTION ESTIMATE *
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SQ. FT. ® $
UNITS
COLL. AREA
B GRADE1 -e
ROUqP PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
ND. REINF. ���$
I IPOWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
EINF. STEEL/GAS
(FINAL)
DRAINAGE PIPING
CAR P. SQ. 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 $
WI
FINAL INSP. - �v
WATER PIPING
NOTE Not to be used as property tax valuation
OFING
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN - EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
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
MESH
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINISH GRADING
SQ.FT.GAR ® 3/ac
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
SETBACKOUNO
PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE1 -e
ROUqP PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
R OR SEPYI� f��
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
ND. REINF. ���$
(ROUGH) /;zo
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
EINF. STEEL/GAS
(FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
WI
FINAL INSP. - �v
n
/FRAMING
V4
FINAL INSP.
OFING
�%
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
L1NSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL