05764 (RPL)4
P.O. BOX 1504 No. 05764
Building 78-105 CALLE ESTADO
Address fig- �. (� LA QUINTA, CALIFORNIA 92253
Owner
VONIDIM'TM BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address
A.P. Number
City Zip Tel.
1 ► Q i:3 Li .. 9W3 * . 564-3795 Legal Description
�� � � _ �� 21555
Contrallk°J.QUL i�I.S BY $ _1 p -.--
Project Description
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Addie :Ls,! 018 V'ISLZE WJLr 91 �A
cityZip
DESERT 292260 .346-6335
State Lic. City
& Classif.63520432 Lic. #
Arch., Engr.,
Designer
Address Tel.
City(Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affrin 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
SIGNATURE . _ v,+ -.r'. "- .. , t .�, . �r".`1#- w'�".'°"i.....�.�.:. " _ DATE
OWNER=BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason (Sec 7031-5,8srness and Professions Code: Any city or county which repines a
Permit to construct, alter, improve, demolish, or repair any structure, prior to its ssuarice also
th
requires e d for such pe nit to We a signed statement that he is licensed pursuant to
the Pmavmwrs of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Llvislon 3 of the Bstess and Professions Code, or that. he is exempt therehom, 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 ($500).
❑ 1, 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
buil or irtproves thereon and who does such work himself or through his own employees,
Provided that such improvements; are not intended or offered for sale. ti, however, the buildmg
or iuprovement is said within one year of completion, the owner-buBder wN have the burden
Of Proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
strict the project (Sec. 7044, Business and Professions Code: The Contractors License Law
does not a pfy to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt udder Sec B. & 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 copyt
hereof. (Sec. 3800, Labor Code.)
de.)Policy Na Company Z_D2'
El opy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
section need not be completed B the permit is for one hundred dollars (S100) valuation
1 cer ify that in the performance of the 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
N0710E 70 APPLICANT.- O, after making this Certificate of Exemption you should became
st�ject to the "bikers' Compensation provisions of the Labor Code. you must forthwith
comply w7b Such provisions or Ihs 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, Civil Code.)
Lenders Name
Lenders 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. '
1 certify that I have read this application and state that the above information is correct
1 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 -
filial ' ling
ateMailing Address
City, State, .Tip
Sq. Ft. tJ No.
KAM` Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Front Setback from Center.Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
Estimated Valuation 10,000.
Issued by:
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
bl,'9t1
Const.
126,00
Mech.
24.00
Electrical
30.00
Plumbing
27.00
S.M.I.
6
Grading
Driveway Enc.
Infrastructure
w
TOTAL
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 DATE
INSPECTOR
Issued by:
Date 5/17/89 Permit
Validated by:
Validation.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. " SQ. FT. ® $
UNITS
ROUGH PLUMB. l _ ;BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR i SQ FT ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR. SQ, FT. ®
FINAL INSP.
BOND BEAM
'
DRAINAGE PIPING
CAR P. SQ. FT.
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
DRINKING FOUNTAIN.
WAIL SQ. FT.
REMARKS:-
EMARKS:VENTILATION
URINAL
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tau valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
MESH
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.
SQ. FT. ® c
BATH TUB
CERT. OCC.
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
INSPECTOR'S SIGNATeRES11NIT1ALS
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GARDEN WALL FINAL
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 PLUMBIY DERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. l _ ;BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK G UGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
(�
REMARKS:-
EMARKS:VENTILATION
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATeRES11NIT1ALS
GARDEN WALL FINAL