04203 (MFD5)104203
P.O. BOX 1504
Building 78-093 CObAlt Drivo 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253 -
Owner ikdlE3i%add Developuent �
'BUILDING: TYPE CONST. " OCC. GRP.
Mailing
Address 777 S. Main a+^t.4 Suite iOra . _ -- A.P. Number,
City I Zip Tel.
Orange 1 92686 1 7144—$47-805 elLegal Description
Contractor 113roject Description ftildii3g !Ry, Plan
ress
Zip [ Tel.
State Lic. City
& Classif. 462814 Lic. # ,
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Sectfon
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 Contractor's License Law for the following
reason: (Sec. 7031.5,Business 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
requires the applicant for such permit 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 thathe 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 penalty of not more than five hundred dollars ($500).
O 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, 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.)
0 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 contractors) 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. O 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 thg work for which this permit is issued, I shall not
employ any parson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, 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 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
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
. _. ._ - .- _.. . .. . . r , -
Sq. Ft. „ ,,, 912NO. No. Dw.
Size Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Garage :included
Estimated Valuation
$165t225
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
U
275 .IS X
Const.
331.00 _
Mech.
36.00
Electrical
44.76
Plumbing
75.00
S.M.I.
4.59
Grading
Driveway Enc.
Infrastructure
l:46yy7
Ns 6
f'-.t'3atl�w"TOGIII
ryr Ve
L >:i�.rd
yy.57
TOTAL
420272.71
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
�y
6128/88
Issued by: Date Permit
Validated by:
Validation:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
. _. ._ - .- _.. . .. . . r , -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES 'vj
NO. PLUMBING FEES
S
UNITS' s
SLAB GRADE 2/
ISI FL SO Fl fp
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
YARD SPKLR SYSTEM
2ND FL SO FT. q
DUCT WORK
ROCK STORAGE
FOUND. REINF. (y
MOBILEHOME SVC.
BAR SINK
POR SO FT. Qr
OTHER APP.IEOUIP.
REINF. STEEL
GAR SO. FT. it
POWER OUTLET
ROOF DRAINS
GROUT
DRAINAGE PIPING
CAR P. I SO FT. fd
FINAL INSP.
WALL SO. FT. rd
_
DRINKING FOUNTAIN
GRADING
cu. yd.
Plus -X$-=$-
_
'
URINAL
SO. FT. 0
FINAL INSP.
FRAMING (O �{.ev
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
'MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTOYDISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
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.
SO. FT. ® c
BATH TUB
SO. FT. g. c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID (g 1VA c
SEWAGE DISPOSAL
SO.FT.GAR 4ic
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
FENCE FINAL
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE bL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING sbl2¢ ELECTRICAL . HEATING & AIR COND. SOLAR .
" S.
SETBACK
GROUND PLUMBING N
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 2/
OaIROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. (y
AS (ROUGH)'
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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 �{.ev
FINAL INSP.
ROOFING
- -
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR•
GAR. FIREWALL
-
LATHING b 12q,107
MESH
INSULATIONISOUND �= 7
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
�
+
GARDEN WALL FINAL
"I