06888 (RPL)T
Building
Address 54-567 Southern Fill?
Owner
_ Stevens
Mailing
Address
A
City Zip
La Quinto 92253
Contractor '
41-910 Board lkp A-73
City Zip
Palm.Deaert 92260
State Lic.
& Classif. 185102
Arch., Engr., -
Designer -
Address'
City Zip
I herebv affi
P.O. BOX 1504 N O . 0608-8
78-105 CALLE ESTADO
W i LA QUINTA, CALIFORNIA 92253 r 1
BUILDING--� TYPE CONST .• OCC: GRP.
A.P. Number PGA •feat
Tel.
Legal Description
Project Description P*01 61 spa.
Lic. # Sq. Ft.
_ Size
Tel.
State
Lic. #
DR'S DECLARATION
ions of Chapter 9 (commencing wift��Secti
ons Code, and my license is'',full'f c� a
No.
Stories
No. Dw.�
Units'
New ❑ Add. 0, Alter ❑ Repair ,E Demolition ❑
' SIGNATURE r I DATE
" OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason_ (Sec. 7031:5,8usbmss-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
• • repines the applicant for such permit to We a signed .statement that he is licensed pursuant to
the provisions of the Contractor's License taw, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions ' Code, or that. he is exempt therefrom, and the basis
. (w rhe alleged exemption. Any violation of Section 7031.5 by 'any applicant /or a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). --
• CII, as owner of the property, w•my,employees with wages as their sole compensation, will
work, do the and the structure is not intended or offered for sale. (Sec. 7044, Suisness and
Rofesskms.Code: The Contractor's License Law does not apply to an owner o/ property who
Estimated. Valuation
/�}��
$14,,0
PERMIT
.
'n AMOUNT, •' '
Plan Chk. Dep.
-� •: .
Plan Chk. Bal.
-
M5.30
Const.
- •rCi�
bw7ds or improves thereon and who does such work himself or through his, own employees,
provided lhat'such improvements are not intended or offered for sale. ff, however, the building
of improvement is sold within one year of completion, the owner -builder will have the burden
- of Provong that he did not build wsrrprove /or the purpose o/ sale. ) _
Mech.
.00 -
Electricalq
- JO.
Plumbing
27.00
❑ I, as owner of the property, am exclusively contracting with licensed contractors to coo-
struct the project (Sec. 7044,•Business and Professions Code: The Contractor's License Law
does not appy to an owner of property who builds or improves thereon, and who contracts for
S.M.I.
. _.
s LA)
such projects* with a cordmctor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. 8 P.C. for this reason
Grading
- -
Driveway Enc.
rF
Date owner
Infrastructure
'
e
i
k
WORKERS' COMPENSATION DECLARATION
• I hereby affirm that 1 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.
TOTAL
r
• CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
51
('� Q e;: +(`-••.i.•yr '
F.:7 is !_.F'.C.s } !" # . �.. 'r ..'.:. .i 4.
(this section need not be completed i/ the permit fs for one hundred dollars ($100) valuation,r*y_p•-,
or less.) _
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
..
`
-
;i
Date Owner
NOTICE TO APPLICANT. H, after making this Certificate of 'Exemption you should become.
' subject to the Workers' Compensation ' provisions o/ the Labor Code, you must forthwith
cmpfy with such Provisions or this Permit shall be deemed revoked. -
ZONE: BY: •�
- -
Minimum Setback Distances:,
Front Setback from. Center Line
Rear Setback from Rear. Prop. Line
CONsrnucnoi4 LENDING AGENCY.
Thereby 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
Side Street Setback from Center Line
Side. Setback from Property Line
Lenders Address
This is'abuildin g permit is sup ended filled out, signed and validated, and is. to . '
expiration if work thereunder is suspended for 180 days. ,
FINAL DATE'
INSPECTOR
1J17%90 ..
certify that'I have read this application and state.that the above information is correct:.
' 1 agree to comply with all city and county ordinances and state laws relating to building"..,.
construction, and hereby authorize_ representatives tot .this city to enter the' -above-.
mentioned property for inspection purposes - ;t
Signature of applicant - .Date
Issued b y
Validated by:
' ' Date Permit
- _
;.
' Mailing Address
Validation: '
City,. State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND Fl- SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
LUMBER GR.
4kEWAL INS J-
FRAMING
URINAL
Sp. 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
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
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3i4c
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
SETBACK
GROUND PLUMBING.
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. 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$-=$
LUMBER GR.
4kEWAL INS J-
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
,
V.
�,
� sof
-Pa e..l�
.lkf, ,� : , J;f 1 F . J DAVUSTEAVENS. "� ° _ .
t
InspectionServices=.:
r
i PROJECT 4fS`i L z "G�'>vic� �' 3 _ PROJECT' r#``r.: c,� F�Ca 3 - co4
`- ADDRESS.S�`%: G ? S�' <,,6dS CLIENT A k i h•tyA
;
DATE .1''i• rhA,t e,,t;pot.
BLDG. PERMIT # ARCHITECT. ,4• 1 AU
ENGINEERI.,,,.t r.l�! J[�r',JG CONTRATOR�t t. /�?A.t f
INSPECTION TYPE
• INSPECTION REP('R'"
t
Y.
AS-
45
V t P1 1l. ft�C1f / moi} { '�� J tCa�-+ ,[„% •,-yt
TION OCERTIFICAF COMPLIANCE:
_ ANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
complies with:approved plans, specifications and'applicable sections of the.building codes. This report covers.
'.Qsubstantial
the tocat i spectid only and does not constitute engineering opinion or project control.
72
_
CERT. NO. C% INSPECTOR NAME r ' r 4 izE'
; . DATE ni' ~J INSPECTOR SIGNATUREZ�,Go-t