05970 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 55— 3-43 Southern Hills LA QUINTA, CALIFORNIA 92253
rhunPr
s1tSA> iaa Co.
Address 75-005 Couatry Club
City Zip Tel.
P.D.92265 X2828
Contractor
Tela
State Lic. City
& Classif. 288130 1 Lic. # 328
Designer -'
Address:, Tel.
City (Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
'(: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. r
SIGNATURE V DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: .(Sec. 7031.5,8usiness and Professkxrs 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 fife 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 crvr7 penafly of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, euisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Bsiness and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. a_ & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($ 100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California
Date " Owner
NOTICE TO APPLICANT. H, after making this Certificate of Exemption you should become
subject to the Workers' Corroon provisions of the Labor Code, you must forthwith
comply with such provisions or this pennit 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, Cin? 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 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
No. 05970
BUILDING: TYPE CONST.
A.P..Number PGA Veat
Legal Description
Project Description Phase 17.8
OCC: GRP.
Flan 100
Sq. Ft. 2272
Size
No.
Stories
No. Dw.
Units
New ® Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
158,646.04
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
•Z
Const.
846-00
Mech.
tail. 0
Electrical
0432
Plumbing
19Z.100
S.M.I.
,
Grading
Driveway Enc.
Infrastructure
359.-
Lose Credit
11d4*17
Iaafra Due
1784,77
TOTAL
&
REMARKS - -- MF- _n�
lit 1s1:G r .r7,°e 7 ?.t, ,; .,
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: Datet19-89 Permit
i
Validated by:
Validation:
' CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
FORMS
ER OR
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
AS (ROUGH) S METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
GROUT
WATER HEATER
DRAINAGE PIPING
CARP. SQ. FT. ®
BOND BEAM
WALL SQ. FT.
DRINKING FOUNTAIN.
LUMBER GR.
URINAL
SQ FT ®
FINAL INSP.
ROOFING `(
ESTIMATED CONSTRUCTION VALUATION $
P
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
CERT. OCC.
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 ACKOUND
PLUMBING
- ! 04
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR
ROUGH WIRING
DUCT WORK
ROCK STORAGE
D. REIN
AS (ROUGH) S METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
4#—INF. STEE�4
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ —Plus—x$—=$
LUMBER GR.
INAL INS�
FRAMING ) 2 -.r-�
FINAL INSP.
ROOFING `(
D1A�
D. Lv. /L."
P
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR, FIREWALL
THING
MESH
INSULATION/SOUND -/11�-01r
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL