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06273 (CP)Building Owner i T4bt 4 P.O. BOX 1504 78-1154 Cobalt Court78-105 CALLE ESTADO . LA QUINTA, CALIFORNIA 92253 Palm Royale Mailing Address Sam City Zip Tel. .La Quiuta 92253 Contractor Address 51-910 Boardwalk Palm Desert 922160 340-900 State Lic. City & Classif. 183102 Lic. # 355 Arch., Engr., Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that t am licensed under provisions of Chapter 9 (commencing with Section 7(700) 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,Busness and Professions Code: Any city or county which requires a permit to construct, after, brprove, demofrsh. or repair any structure, prior to its issuance also requires the applicant for such permit to fife 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 Prolessions 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). ❑ 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 Contradoes License Law does not apply to an owner of property who builds or inproves thereon and who does such work henself or through his own employees, provided that such s/Iprovement8 are not mended or offered for safe. 11 however, the building. or improvement is sold within one year of corrpletion, the owner -builder will have the burden of proving that he did not build or Ji prove 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 bnproves thereon, and who contracts for such projects with a contractor fs) licensed pursuant to the Contractor's License Law.) - ❑ 1 am exempt under Sec R. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 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 O 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 pennit 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 any person 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 proviskim 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 property filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 1110 days. 1 certity that I have read this application and state that the above information is correct. 1 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 r No. 06273 i BUILDING: TYPE CONST. OCC: GRP.- A.P. Number Palm Royale Legal Description Project Description Pool & fta - Car'= Area Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $21,500 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. $ 146. Const. • Mech. Wow Electrical Plumbing • Q S.M.I. • 54 Grading Driveway Enc. Infrastructure 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 9J12/89 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES + NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS A.C. UNIT 4 SLAB GRADE YARD SPKLR SYSTEM 2ND FL SQ. FT. @ BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR. SO. FT. ® ROUGH WIRING. GAR. SO, FT. ® POWER OUTLET ROOF DRAINS GAS (ROUGH) P fJ Ci DRAINAGE PIPING CAR P. SO. FT. ® HEATING (FINAL) OTHER APPJEQU1P. WALL SQ. FT. GAS (FINAL) DRINKING FOUNTAIN. 1 EMP. POLE URINAL SO FT ® GROUT WATER HEATER ESTIMATED CONSTRUCTION VALUATION $ SERVICE 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 FINAL INSP. 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. SO. FT. ®c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1 *1a c SEWAGE DISPOSAL SO.FT.GAR ® 3ec HOUSE SEWER LATHING 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 SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) P fJ Ci �ER LOOP HEATING (FINAL) OTHER APPJEQU1P. REINF. STEEL GAS (FINAL) 1 EMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. -Plus-X$-=$ LUMBER GR. FINAL INSP. © FRAMING FINAL INSP. ROOFING REMARKS: VENTILATIONy�Adr FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION-?--?-- 0/0 7 CERT. OCC. FENCE -FINAL_ INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 1