05426 (SFD)z:7 T4ht 4 4 Q"
Building
Owner
Mailing
Address
City
P.O. BOX 1504
78-105 CALLE ESTADO
No.
54-555- SOMIMM R=S LA QUINTA, CALIFORNIA 92253
SCfMSE cwxly
BUILDING: TYPE CONST. OCC: GRP.-.
42-6 t�iOP. S�S�, SM 200 ... � , .� ,..
A.P. Number
pWX DES Zip 92260 Tel. �5$-72,28 Legal Description
TONAL XpR CE Project Description G2 A Mid 1E
ress .
SAM,_ .
Tel.'
State Lic. City
& Classif. 280130 Lic. # 208
Arch., Engr.'
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
70DO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
_SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Businass and Professions 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 permd 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
subjects the applicant to a civilpenalty 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, Suisness 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 irnprovements 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 orsnprove for the purpose of sale.)
❑ 1, 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 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 (S100) valuation
or less.)
I certify that in the performance of the 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 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 it 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
45426
SOD
Sq. Ft. 3355 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuation 243,165
PERMIT
AMOUNT
Plan Chk. Dep.
Distances:
Plan Chk. Bal.
Front Setback from Center Line'
Const.
Rear Setback from Rear Prop. Line
Mech.
81.50
Electrical
184017
Plumbing
180.50
S.M.I.
27.08
Grading
Issued by:
Driveway Enc.
Validated by:
Infrastructure
i4 •Z�
LESS (AW1,71—
!4.135.611
111-M DUE
TOTAL
,dJ1.3
REMARKS y s{�c;�� �yL li j
�t71.t5 ift .f IliZMAU 6 —0v'n , 5, t 0
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
3/31-89
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SQ. FT. @ $
UNITS
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR SQ FT ®
ER OR SEPTIAA
ROUGH WIRING
POWER OUTLET
ROOF DRAINS
GAR SQ. FT. ®
FOUND. REINF.
GAS (ROUGH) , �_
METER LOOP
DRAINAGE PIPING
CAR P. SQ. FT. ®
INF. STEEL
WALL SQ. FT. ®
GAS (FINAL)
DRINKING FOUNTAIN,
URINAL
SQ FT ®
WATER HEATER
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE Not to be used as property tax valuation
BOND BEAM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
r I�
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.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi 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 fPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
S BACK
OUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE —
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SEPTIAA
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) , �_
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
INF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus —X$—=$
LUMBER GR.
FINAL INS F � -�
NV
f
G /
FINAL INSP.
OOFING /
r I�
REMARKS:
//)-VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
,G7 FIREWALL
HING 1 7
M H
CATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITtALS
'
GARDEN WALL FINAL