06006 (SFD)P.O. BOX 1504 N o . 06,006
Building 5.1-'633 Southern Rills78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
$tSnriae. Co.
MailinAddress 75-005 Coiner Club _
CityZip Tel.
P.D. 92260. 568--2$28_
Contractor
.. Sam,
Address
State Lic.'
& 288130
Classif.
Engr.,
Arch:,
. Dgsignep•
Address
el.:
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Phase 1.9g PIga 4
City
Lic. # 328 , , , Sq. Ft. 3142 No. . No. Dw.
Size Stories Units
Tel.
City.I Zip I State
"i�-: Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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.
SIGNATI1gE DATE
OWNER -BUILDER DECLARATION
I 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, 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).
❑ 1, 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 -budder will have the burden
of proving that he did not build or knprove for the purpose of safe.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to corn'
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 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 (E100) 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
Ihereby 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 properly filled cut, signed and.validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 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
New N Add ❑ Alter ❑ Repair. ❑ Demolition ❑
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center,Line
Estimated Valuation
215,834.00
Side Street Setback from Center Line
PERMIT
Side Setback from Property Line
AMOUNT
Plan Chk. Dep.
INSPECTOR
Plan Chk. Bal.
Issued by:
9 •' 3
Const.
\
Validated by:
Mech.
2.30
Electrical
133.4.7
Plumbing
210.
S.M.I.
• -�
Grading
Driveway Enc.
Infrastructure
•
Less "eulit
24za. S
Intra Eve
Z428 t3
TOTAL
• 3
REMARKS
�,r >.w Fa.:,rT'..n..i_MO..,r:
4 A
1"LIU✓ "•�+t'isJ;Tl' s ° <d �`�1 .YtYi:... L:... `-7'i r M < e .. .....
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
Issued by:
Date Permit
\
Validated by:
Validation:
V.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
GRADE
RO GH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SE
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
S (ROUGH) `b
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.
L ER GR.
FINAL INSP.
RAMING
URINAL
SQ. FT.
D ' 1
yl/
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
GAR. FIREWALL
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.
SO. FT. ® c
BATH TUB
FINISH GRADING
SQ. FT. ®c
IWATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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
SETB K
OLIND PLUIMBING46�p
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE
RO GH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SE
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
S (ROUGH) `b
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ -Plus-X$-=$
L ER GR.
FINAL INSP.
RAMING
FINAL INSP.
*C16FING 17K&10
D ' 1
yl/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
AfW ING `' Cd
ESH
SULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
lC?9 -.:�Z