06012 (SFD)4
P.O. BOX 1504 N o . 06012
Building 78-105 CALLE ESTADO
Address 55-197 Southern Rile LA QUINTA, CALIFORNIA 92253
Owner
suar CO.
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 75--005 ry Club _ A.P. Number PE'iQ� veer
City Zip Tel.
P. 92260 5i -2828 Legal Description
Contractor Project Description tfiBQ boa i'4A « cuc
.Address
City Zip
State Lic.
& Classif. 21130
Arch-, Engr.,"
r. e.
Address
t.;lly
Lic. # 328 Sq. Ft. 3142 No. No. Dw.
Size Stories Units
City I
Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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 DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
'i permit to construct, after, Improve, demolish, or repair any structure, prior to its issuance asD
requires the applicant for such permit to file a signed statement that hes licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Dwwon 3 of the business and Professions Code, or that. he is exempt therefrom, and the bass
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, gess and
Professions Code: The Contractor's License Law does not apply to an owner of property who
buids or improves thereon and. who does such work himself or through his awn employees,
provded that such improvements are not intended or offered for sale. 11 however, the building
or improvement is sold within one year of completion, the owner -builder wm7 have the burden
.. of proving that he did not build or inprove for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, business and Professions Code: The Contractors License Law
does not apply to an owner of property who buddy or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractors License Law.)
❑ 1 am exempt under Sec. R• & P.C. for this reason
Date Owner
.1
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 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 da8ars ($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
aliforniaDateOwner
NOTICE TO APPLICANT, If, ager making this Certificate of Exemptkm you shoukf become
subject to the Workers' Compensation provisions of the Labor Cade, you must forthwilh
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDINGAENCY
I hereby affirm that there is a construction lending agency for the perfornance 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 if work thereunder is suspended for 180 days.
I certity that I have read this application and state that the above information is correct
('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
New m Add ❑ Alter ❑ Repair ❑ -Demolition ❑
stimated Valuation 215,834.00
BY:
PERMIT
AMOUNT.
Plan Chk. Dep.
Plan Chk. Bal.
f
Const.
MO.
Mech.
uZa
Electrical
.4
Plumbing
6_19-89 Permit.
S.M.I..
Date
Grading
Driveway Enc.
Validation:
Infrastructure • Z
LeSS Cred1t z
Infra Due
TOTAL 3.
REMARKS - res, a a . }. n Ax"-,; rnru, .ri
"�a
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_19-89 Permit.
Issued by:
Date
Validated by:
Validation:
1. . I ► CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
LAB GRADE
ROUGH PLUMB.-
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCKSTORAGE
UND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P.. SO. FT.
WALL SO. FT.
WATER HEATER
DRINKING FOUNTAIN.
FINAL INSP.
URINAL
SO FT ®
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
-CU. yd.
plus x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP. ` J
FLOOR DRAIN
MECHANICAL FEES
OFING �( (�'
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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 ® 1+/4 c
SEWAGE DISPOSAL
I SULATION/SOUND .�
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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 GOND. SOLAR
SETBACK
UND PLUMBINC?
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE
ROUGH PLUMB.-
BONDING
i
HEATING (ROUGH)
STORAGE TANK
FORMS
OR SEPTIC TANK
ROUGHMIRING
DUCT WORK
ROCKSTORAGE
UND. REINF.
//SEWER
/NGAS (ROUGH) 12--)040
II
METER LOOP
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$
=$
LU BER GR.
FINAL INSP. ` J
ING IV -7
FINAL INSP.
OFING �( (�'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING (5
MESH
I SULATION/SOUND .�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
t