05994 (SFD)T4,1f 4 4 "
P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 55-107 SOttbe1n M113 LA QUINTA, CALIFORNIA 92253
Address 75 -WS Co=try Club ,
City Zip Tel.
P.D. $2260 568-28,28
Contractor
Stam
Address
City IZiD I Tel.
State Lic. I City
& Classif. 288130 Lic. # 328
Arch., Engr.,
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
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
I herebyr3ffirm 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, after, brpmve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such perm# 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 viWation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a chril penafty 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 bnproves 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
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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 # the perrm7 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: ft, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisiorms of the tabor Code; you must forthwith
comply with such proviskons 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, CivaCode.)
Lenders Name
Lenders 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 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
11LDING: TYPE CONST. OCC: GRP..
P. Number PGS' test
Legal Description_
Project Description
05994.
Phase 148 Plan 10MR
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Sq. Ft. 22112
-Size.
No.
Stories
No. Dw.
Units
Newt] Add ❑
Alter ❑
Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
Issued by:
Date6'19 89 Permit
Validated by:
Validation:
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Q '6771 7
Const.
4 -w
Mech.
.9
Electrical
IM 1
Plumbing
q2 WW
S.M.I.
H.13
Grading
Driveway Enc.
Infrastructure
3569.53
Less Credit1784.77-
Infra. Due
x t3t�. l
TOTAL
REMARKS
. EkAl� r to^��,trzi:44 �r:� ii..s.'aA ._F40A-t t o 4 {
.L tk'�-••: •aLiYYI3.fb"h' Y J'cY rti--•4 _ 1— .�.. .. ...,.
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:
Date6'19 89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® =
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SQ. FT.
DUCT WORK
ROCKSTORAGE
O D. REINF.
MOBILEHOME SVC.
BAR SINK
FOR. SQ. FT. ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRAINAGE PIPING
CARP. SQ. FT. ®
LU BER GR.
/FINAL INSP. r`�'
ING GL
FINAL INSP.
DRINKING FOUNTAIN.
WALL SQ. FT.
REMARKS:
URINAL
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
M SH
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
CERT. OCC.
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
INSPECTOR'S SIGNATURESIINITIALS
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.FEET
NST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
S ACK
ROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FOAl MS
EWER OR SEPiI ROUGH WIRING
DUCT WORK
ROCKSTORAGE
O D. REINF.
GAS (ROUGH) _ _ 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. r`�'
ING GL
FINAL INSP.
OOFING�( Z
�. • "`� �� /� �lf�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
RIZATHING
M SH
SULATIONISOUND J
` 1 Lily
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL