04157 (GRES)T�A -
I - P.O. BOX 1504
Buildin,78-105 CALLE ESTADO ;
Addrress 7 " . �i' , Terra �®�� �'� it LA QUINTA;-CALIFORNIA 92253
Owner r c
'Rotl:3v�4rd,Deveil P.�'ten BUILDING: TYPE CONST. OCC. GRP.
Address 613--790-001
+� • 1,•14in Set . , suite 106 A.P. Number
City Zip JTeI_ ' ' ` ' . ' '
Grange X2630 46 Legal Description
Contractor - Project Description Building IIS Phil I.
Address
City Izip I Tel.
State Lic.
8 Classif.
Arch., Engr.,
Designer
Address
462814I Lic. # I S4. Ft. 926 No.
Size' Stories
Tel.
CityI Zip I State
Lic. #
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. e
SIGNATURE+ -'u •" DATE
OWNER -BUILDER DECLARATION
I hereby affirm.that I am exempt from the Contractor's License Law for the following
reason: (Sec.,03
70 Y. Business and Professions Code: Any city or county which requires a
permit to construct,,.. after, 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 Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe 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 civil penalty 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 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 sale.)
❑ 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.)
❑ 1 am exempt under 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 copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company a
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 if the permit Is for one hundred dollars ($100) valuation
or less.)
1 certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner '
NOTICE TO APPLICANT: If, alter making this Certificate • of Exemption you should become
Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. .
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency,for.lhe performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name .
Lender's Address '
This is a building permit when properly filled out, signed and.validated, and is subject to.
expiration If work thereunder is suspended for 180 days. • -
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above- ,
mentioned property for inspection purposes. '
Signature of applicant Date '
Mailing Address
'City, State, Zip '
WHITE - FINANCE, PINK APPLICANT, GREEN - BUILDII
No. Dw.'
Units
New ❑ Add ❑ Alter ❑ Repair ❑ i Demolition ❑
Estimated Valuation��
PERMIT
AMOUNT
.Plan Chk. Dep.
ZONE:
Plan Chk. Bal.
Minimum Setback Distances:
r r"
Const.
_3341600
Mech.
Side Street Setback from Center Line
36.00
Electrical
FINAL DATE
45,04
Plumbing
6/27/89 �. •_
; 75.00
S.M.I.
Validated by:
4 y ()6 '
Grading
Driveway Enc.
.
4G, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE `�,
Infrastructure
Fringe -Toed
X I6!rd
38.46
TOTALa'�I.31
r-.. S•:�{1, E::
9M
M
REMARKS
.-.r r .. A'1�1; 4.1LiF �..,SKl3 ���$:?('C:..�%J"'�FS7;�'t'i ��,�•'..7. �+ '
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
6/27/89 �. •_
Issued by:
Date Permit -
Validated by:
Validation:
1
I
.
4G, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE `�,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO Fl (p $
UNITS
COLL. AREA
;P
LAB GRADE)2,— g
'
YARD SPKLR SYSTEM
2ND FL SO FT. a
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FTa
DUCT WORK
ROCK STORAGE
UND. REINF./Z -��
!
POWER OUTLET
ROOF DRAINS
GAR SO. FT. fila
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO FT. 0
GROUT
WATER HEATER
FOUNTAIN
WALL SO. FT. (dDRINKING
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. d
GRADING
cu. yo.
$ plus x$
_$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
/
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 1'A c
SEWAGE DISPOSAL
SO.FT.GAR 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEEiMECH.FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
4�� PLUMSINu�Z Z
UNDERGROUND
A.C. UNIT
COLL. AREA
;P
LAB GRADE)2,— g
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
AGAIS(ROUGH)
ROUGH WIRING
DUCT WORK
ROCK STORAGE
UND. REINF./Z -��
!
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yo.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
RA (32:" �.C{
FINAL INSP.
ROOFING
/
� ^
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR!
Gta FIREWALL
TH -
MESH
jusu IATIONISOUND
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS ,
GARDEN WALL FINAL