06855 (SFD)P.O. BOX 1504
Building78-105 CALLE ESTADO
Address 44-156 Swetbush Lace LA QUINTA, CALIFORNIA 92253
Owner
La Qainta Associates
Mailin
Address 43-875 .Washington St..
City Zip Tel.
..Palo Desert . 92260 345-7541
Contractor
E.S. Williams gev. Corp.
Address . .
State Lic. City
& Classif. 493919 Lic. # 1231
Arch.; Engr.,
Designer
Address 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
7(100) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec'. 7031.5,Business and Professions Code: Any city or county which requires a '
permit to construct, alter, 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 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 civil penalty of not more than five hundred dogers ($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. ff, 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.).
❑ 1, 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 ir�,r3 Owner
,e
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
❑ Copy is filed with the city. . ❑ 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.)
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: 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
I=firm
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
No. 05855
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number Tract 22982 ` Phase IV
Legal Description Cactus _dower
Project Description Plan 2A -'Lot 119
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
1/10/90
Issued. by: Date Permit
Validated by:
Validation: '
Sq. Ft. 1621
Size
No.
Stories {
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
7e14
PERMIT
AMOUNT
Plan Chk. Dep.
, _
ti
Plan Chk. Bal.
•77
^+
Const.
Mech.
_ �3• ;5^
Electrical
1,04.
Plumbing
rJ�
S.M.I.
dr lid
Grading
Driveway Enc.
_
Infrastructure
els
TOTAL
�3s��
•� -}S a r {. - l
REMARKS
r4nr, e�+9 mfr .- n Lrs a 1_..Isa_a > 4xcg
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
1/10/90
Issued. by: Date Permit
Validated by:
Validation: '
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER R
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK'
POR SO FT ®
GAS (ROUGH)
L� G� METER LOOP
G
POWER OUTLET
DRAINS
GAR. SO. FT. ®
GAS (FINAL)
IROOF
DRAINAGE PIPING
CAR P. SO. FT. ®
WATER HEATER
\
SERVICE
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SO FT ®
GRADING
cu. yd.
$ plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
NSP. (O Lp 4D
FINAL INSP.?/(0/416
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING
FLOOR DRAIN
MECHANICAL FEES
g
// Q
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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
ND PLUM BING3 If UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE07oROUGH
PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER R
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. o7i�
GAS (ROUGH)
L� G� METER LOOP
G
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
\
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
NSP. (O Lp 4D
FINAL INSP.?/(0/416
FRAMING �9 %
/
FINAL INSP.
ROOFING
g
// Q
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND6 , 9
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL