05999 (SFD)44
P.O. BOX 1504 , No. 05-999
Building 34iut�t@I> i 7&105 CALLE ESTADO
Address LA,QUINTA,,CALIFORNIA,92253_
Ownersmrise C
o.
Mailing
Address 75-005
Country Club
City
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
Zip
- P.wD 9.
permit to construct, after, improve, demolish, or repair any- structure, priorto its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
92260
Contractor
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
Sam
subjects the applicant to a civil penalty or not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Address
Const.
City
Mech.
Zip
State Lic.
8&20assif.
or improvement is sold within one year or completion, the owner -builder will have the burden
Arch.', Engr.,.
.Designer .�
Address
BUILDING: TYPE CONST. OCC: GRP.•
A.P. Number, g � 8•SL" �.
Tel. -
y
568-2828_,:__ Legal Description
'
.. Project Description Paste19B Plan 20M"
City 4
Lic. # 328 Sq.Ft. ,. - r No.,
Size Stories
t" -City Zip State
LIC. #
d LICENSED CONTRACTOR'S DECLARATION
I 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, r. ; ,r • ✓
New ( Add ❑ Alter ❑
SIGNATURE`- DATE
• OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
- PERMIT -.
permit to construct, after, improve, demolish, or repair any- structure, priorto its issuance also
requires the applicant for such permit 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 violation' of Section 7031.5 by 'any applicant for a' permit
- -
Plan Chk. Dep.
subjects the applicant to a civil penalty or not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk.. Bal.. ,
Const.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Code: The Contractor's License Law does not apply to an owner of property who
Mech.
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 safe. If, however, the building
_ Electrical T
or improvement is sold within one year or completion, the owner -builder will have the burden
of proving that he did not build or approve for the purpose of sale.)
;.: ❑ I, as owner.of the property, am exclusively contracting with licensed contractors to con- Plumbing
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 - S.M.I.,
o such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. 8 P.C. for this reason Grading
Driveway Enc.
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 , � .y
O 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, 1 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 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 properly 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 " 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
Infrastructure
T-ae n J!"* 4�P
No. Dw. ,
Units
Repair ❑ -Demolition p
1791,818.00
AMOUNT
.. 163a17,
1919.30
82.50
13 36
N\—
TOTAL• y' t ,l.f - •-.1"' A
REMARKS ;itB 4'.t A.
,I •c:rfan- `X. `►;y't c•s5•..'
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line • = '` :' : sti;
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
LAB GRADE
R UGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEW OR SEPTICTokw
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
(ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
L MBER GR.
FINAL INSP.
XIF.AAMING
URINAL
SQ. FT.
04 o ,l✓j/
/�'�
p
1002/q/
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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GA FIREWALL
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
FINISH GRADING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
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
ACK
ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE
R UGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEW OR SEPTICTokw
ROUGH WIRING
DUCT WORK
ROCK STORAGE
D. REINF.
(ROUGH)
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 MBER GR.
FINAL INSP.
XIF.AAMING
FINAL INSP./ 2--f$
OOFING
�� YJ
04 o ,l✓j/
/�'�
p
1002/q/
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GA FIREWALL
HING ��
ME H
LATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATU RESIINITIALS
GARDEN WALL FINAL
t