05417 (SFD)I • 4 4 " `
V
P.O. BOX 1504 No. 05427
Building
Address 540287SOB�N HMS LA QUINTA, CALIFORNIA 922.5.3
Owner S33 TSE WAPANX
Mailing BUILDING:. TYPE CONST. OCC: GRP. -
Address 42-600 GOOK STREET, STE 200
A.P. Number
City Zip Tel.
PAM DESS 92260 558-2828 Legal Description Gil 13R
Contractor Project Description PWE 1E SFD
W1 10M MIRTGAGE
Address
SAMB
City Zip Tela
State Lic. City
& Classif. 288134 Lic. #- 20B Sq. Ft. No. No. Dw.
Size- 3401 - Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Address Tel.
City I
Zip I
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.
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business 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 Contrictor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 or 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 rive hundred dollars (8500).
❑ I, 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. If, however, the building
or improvement is sold within one year or completion, the owner -builder will have the burden
or proving that he dM not build or improve 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.lmproves 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 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, I shall not
employ anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: N, after making this Cer i tcate of Exemption youshould 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.
Y c
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.)
Lenders Name
Lenders 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 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
TOTAL
REMARKS
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
Issued by: Date 3/3/89 Permit
Validated by:
Validation:
Estimated Valuation 24.2,434
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
I t L40.00
Mech.
ST.- 5
Electrical
183.9`
Plumbing
1..80.50
S.M.I.
17.01
Grading
Driveway Enc.
Infrastructure 5,454.65
Ss 1- t 12,121.341
Infra Due
2,7Z7.34
TOTAL
REMARKS
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
Issued by: Date 3/3/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
LAB GRADE
ROU H PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
OR SE C N
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
I
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL SO. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ —Plus—X$—=$
URINAL
SQ FT ®
R ING /16 9 /�
fi 'd
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
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
AABSORPTION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
IKITCHEN SINK
SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
I POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
LATION/SOUND
W-21
SO. FT. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.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
SETBACK
NO PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE
ROU H PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
OR SE C N
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REINF.
6
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL 00'GAS
(FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
AL INSP. �—
R ING /16 9 /�
fi 'd
FINAL INSP.
DOE NG
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALLIr
�J
LNG 1 , `-u
MESH
LATION/SOUND
W-21
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL