06001 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 55-017 Southern 81124 LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75-005 Country Club
City
J%22_60
Tel.
P.D. 56$-2$$
Contractor _
Address
State Lic. 21d (City �2$
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
`" • Lic. #
LICENSED CONTRACTOR'S DECLARATION
I -hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7p) t.of Division 3 of the Business and Professions Code, and my license is in full force and
SIGNATURE DATE
OWNER -BUILDER DECLARATION
' I hereby affirm that 1 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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 rive 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.
, slruct 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.)
O 1 am exempt under Sec B. & 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. 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 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
NOTICE TO APPLICANT, M, 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 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.)
Lender's Name
Lender's Address
This is a building permit -when property 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. 06001
BUILDING TYPE CONST: OCC: GRP.
A.P. Number PSA We.8t
Legal Description
Project Description Phase 19B PIsa 20H
ZONE: . BY:
Mi4mum 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 1 INSPECTOR
Issued by: Date 6-19-89 Permit
Validated by:
Validation:
Sq. Ft.
Size 2596• -
No.
Stories
No. Dw.
Units
New IX Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
iT3 $18.i3iJ
'
PERMIT.
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
761.17
Const.
919.50 -
Mech.
$21.50 ;
Electrical
134 �,Z(
Plumbing
198.00
S.M.I.
1..60
Grading.
Driveway Enc.
Infrastructure
4445.90
s><credit
2022.95
...,
gom..2 9. 95
TOTAL
REMARKS
ZONE: . BY:
Mi4mum 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 1 INSPECTOR
Issued by: Date 6-19-89 Permit
Validated by:
Validation:
I ` CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
B GRADE 17
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
/
ER OR SEPTI A
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH�J
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT.
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SQ. FT. ®
_$
LUMBER GR.
INSP,
NG l /
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(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
R FVSWALL
THING l jZ. (
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FENCE 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
S BACK
IOUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
B GRADE 17
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
/
ER OR SEPTI A
ROUGH WIRING
DUCT WORK
ROCK STORAGE
F ND. REINF.
GAS (ROUGH�J
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
INF. STEEL l
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$
_$
LUMBER GR.
INSP,
NG l /
FINAL INSP.
I-OOFING !v 3U
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
R FVSWALL
THING l jZ. (
MES
VFfu-TIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES1INITIALS
GARDEN WALL FINAL