04955 (SFD)) JA � •
2
S4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-839 Stmal Creek LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 42-600 Coo
City Zip
Contractor
Tel.
5 68
Tela
State Lic. City
& Classif. 288134 Lic. # 328
Designer
Address Tel.
No. 44955
BUILDING: TYPE CONST. OCC: GRP.
} A.P. Number PCA Wast — Tract 20717-3
City I
Zip I State
Lic. #
r 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 f?. ♦ ,
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affinn that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13ushess and Professions Code: Any city or county which requires a
permit to construct, alter, irprove, demoish, or repair any structure, prior to its issuance also
requires the applicant for such pemdt to tie a signed statement that he is licensed pursuant to
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 chd penally 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 Contractors License Law does not apply to an owner of property who
builds or improves thereon and who rhes such work haamelf 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.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Litiress 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.)
❑ 1 am exempt under Sec S. & 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. 3800, Labor Code.)
Policy No. Xompany
❑ Copy is filed with the city. ❑ Certified copy.is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed d the pemnd is for one hundred dollar; ($100) valuation
or less.)
I certify that in the performance of tAg work for which this permit is issued, I shall not
employ rty any person in amanner so as to become subject to the Workers' Compensation
Laws of
California-
Date-Owner
aliforniaDateOwner
NOTICE TO APPLICANT: ff,after making this certificate of Exemption you should become
subject .to the Workers' Cawpesafion provisions of the Labor Code, you must forthwith
comply with such provisions of this pemd 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
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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
T
Legal Description
Project Description
PhoLsi- 1 7A
PIAxt §('
Sq. Ft. 24899
Size
No.
Stories
No. Dw.
Units
New ❑ Add-❑
Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation
$170,208
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 500.90,
Const.
&101 • so,
Mech.
33.00
Electrical
113.52
Plumbing
111.001
S.M.I.
11.94
Grading
Driveway Enc.
Infrastructure
$3,889.68
, 914 . 84
Less Crtd9it
19'14.84
r
TOTAL
.$3,295.70
REMARKS
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 DATEINSPECTOR
12/8/88
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ, FT. ®
G (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TE P. POLE
I
GROUT
DRAINAGE PIPING
CARP. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SQ. FT. ®
=$
LUMBER GR.
FINAL INSP.
FRAMING
URINAL
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOHDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
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. �'
SO. FT. ® c
BATH TUB
7111SH GRADING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.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
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
G (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
(FINAL)
TE P. POLE
GROUT
WATER HEATER
ICE —ff
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
7111SH GRADING
INAL INSPECTIONS
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1