05421 (SFD)P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 54-027 SOUTHM HMS LA QUINTA, CALIFORNIA 92253
SUNS$ CMTANY
Mailing
Address 42-600 ODOR STREET, STE`200
- • -
City Zip Tel. '' •`
PALK DES 92660 568-2828
Contractor NATIONAL MORTOWE
Address. * »
SME
City Zip Tel:
State Lic. City
& Classif. 288130 Lic. # 208
Arch., Engr.,
Designer
Address Tel.
City (Zip ( State
Lic. #
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. , - _ .1 rte- X,
SIGNATURE DATE
OWNER -BUILDER DECLARATION'
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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 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 penally of not more than five 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 sate. (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. 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 sale.)
❑ I, 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
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) 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: N, 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 1 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
05421
BUILDING: TYPE CONST.
A.P. Number
Legal Description MLLEMS
Project Description C2 BR
SFD
OCC: GRP.
FUSE. IL
Plan Chk. Dep.
Distances:
Plan Chk. Bal.
•
Const.
s 3,, fi31
Sq. Ft- 3355
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
S.M.I.
i7.
Grading
Issued by:
Driveway Enc.
Validated by:
Infrastructure
5,471.22
LESS CREDIT
IT,735.611
MM HU
2,735.61
Estimated Valuation
243,165
5,271.52
PERMIT
AMOUNT
Plan Chk. Dep.
Distances:
Plan Chk. Bal.
•
Const.
s 3,, fi31
Mech.
.5
Electrical
184.1
Plumbing
18.0..50
S.M.I.
i7.
Grading
Issued by:
Driveway Enc.
Validated by:
Infrastructure
5,471.22
LESS CREDIT
IT,735.611
MM HU
2,735.61
TOTAL
5,271.52
REMARKS
,K31K•"�"'Kti'1iS'!° A.;_r+`..Y1 &:R.:' •� "i+":: ; A a w
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
3/3/89
Issued by:
Date Permit
Validated by:
Validation:
2_ CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
B GRADE
! UGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
FORMS
SEWER OR T
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT ®
0UGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
I
GROUT
DRAINAGE PIPING
CAR P. SO. FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SO. FT.
LUMBER GR.
FINAL INSP.
04
MING ��
URINAL
SO FT ®
�:."7�j .- p �
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
ARK A REESSTT�OR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
AR. F
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
FINIS)l GRADING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/+ c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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
B GRADE
! UGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR T
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
0UGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
(FINAL)��{
r
TEMP. POLE
GROUT
WATER HEATER
VICE Zs
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INSP.
04
MING ��
FINAL INSP.
ROOFING�l�
�:."7�j .- p �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
ARK A REESSTT�OR
AR. F
LATHING
SH
I LATIONISOUND
FINIS)l GRADING
SAI-INSPECT10N1� y
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURE&INITIALS
GARDEN WALL FINAL
t