06721 (SFD)44
P.O. BOX 1504 No. 06721
Building 78-105 CALLE ESTADO
Address 54-625 VallaJo LA QUINTA, CALIFORNIA 92253
Owner
mauing
Address P. d. Hoax 772
CityZip Tel.
La Quint a 92253 198-4419
Contractor
Address.
P. Q. Box 1371
City LA Zip Tel.-
111vit t 2.293 564
State Lic. City
& Classif. _ _ _ _ _ _ luc.#
Designer
U
City lZipStateI
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under prursions of Chapter 9 (commencing with Section
7000) t.of Division 3 of the Business and Professions Cade, and my license is in full force and
effec
_SIGNATURE DATE
0WNER41URDER DECLARATION
I hereby affirm that I am exempt from the Contractors License taw for the following
reason: (Sec. 7031.5,8ushess and Prdessios Code=. Any city or county which requires a
Permit to constrict, after, improve, I P or rmpaii army sbucD+e, prior to its Issuance also
requires the applicant for such permit to file a signed statement that hes licensed pursuant to
the provisions of the ConbactoiS license Law. Chapter 9 (oommencimg with Section 7000) of
Division 3 of the Business and PnxVsskm Cod or that -he is exempt therefrom, and the basis
for the alleged exenpffon. Any vkkftn of Secti m 7031-5 by any app6cermt for a permit
subjects the applicant to a cvd penalty of not more than Live hu dl ed dogs ($500).
❑ I, as owner of the properly, or my employees with wages as !heir sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code. The Contractors Liamw law does not appty to an owner of property who
builds or improves thereon and who does such wank hinseff or through his own employees,
provided that such impmverrmen6 are not intended or offered for safe. !f, however, the building
orimprovement is said within am oyear of compliffm the owner-0ulrler wig have the burden
of, proving that he did rwt build orrrprove fior the Propose of salle_)
❑ I, as owner of the property, am.excdusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Business and PhAessimms Code. The Comractors License Law
does not apply to an owner of property who budrs or improves thereon, and who contracts for
such projects with a conbactor(s) licensed pursuant to the Contractor's License Law.) '
O 1 am exempt under Sem J1 & P.a for this reason
Date Owner
WORKERS COLLATION DECLARATION
I hereby affirm that 1 have a certificate of consent to seWinsur% or a certificate of
Workers Compensation Insurance, oracertified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXB[PRON FROM
WORKERS COLP1136ATION INSURANCE
(This section need not be corrpkted d the - 9 is for one hundred doftars (E100) valuation
or less.)
I .certify that in the performance of tip wort for which this permit is issued, I shall not
employ became subject person in any manner so as to becamsubject to the Workers! Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: C, after m#img die Certificate of Exemption you should become
subject to the Workers' Compensation, prooiseons of the Labor Code, you must forthwith
comply with such Provisions or this permit sha/ be deemmed revoked -
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a consbuctian lending agency for the performance of the.
work for which this permit is issued. (Sec- 3097, ChdCode.)
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 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 repinmehtatives of this city to enter the above.
mentioned property for inspection purposes
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. OCC: GRP,
A.P. Number 774-281-019-03
Legal Description
Project Description SF$
Sq. Ft.No. No. Dw.
Size. 1530 Stories. Units
New ❑ Add ❑ .Alter ❑ Repair ❑ -Demolition ❑
REPLACES PMWIT NO. 6093
Estimated Valuation
$87.,010
Minimum Setback
PERMIT
AMOUNT
Plan Chk. Dep.
$250.00
Plan Chk. Bal.
335.50
Const.
FINAL DATE
5$5.50
Mech.
12/7/89
69,00
Electrical
Validated by:
113.13
Plumbing
Validation:
178.50
S.M.I.
6.16
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1.919.48
TOTAL
$3,488.47
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
12/7/89
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUBSBING FE ;
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL AREA
SLAB GRADE —� _
YARD SPKLR SYSTEM ~
2ND FL SO. FT.
BONDING
HEATING (ROUGH)
MOSILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WIRING.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GAS (ROUGH)
METER LOOP
DRAINAGE PIPING
CAR P. SO. FT. ®
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN.
WALL SQ. FT.
GROUT
WATER HEATER
URINAL
SQ. FT.
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
$
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(ALTOXDISH)
APPLIANCE DRYER
_
ROOFING ��
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® Wac
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 -;Z,3 —P `f
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE —� _
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
S ICTAe
ROUGH WIRING.
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPIEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING / O
FINAL INSP.
_
ROOFING ��
p /y/�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING N
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL