06645 (BLCK)P.O. BOX 1504 No. 06645
Building 78-105 CALLE ESTADO
Address 78--150 La Fouda _ LA QUINTA, CALIFORNIA 92253
Owner
Gene ail. Telephone ------
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address Sam � A.P. Number 769-084--011
City Zip Tel.
La Ouiuta 92253 Legal Description
Contractor Project Description
a n
Address...
P. 0. Box 1321 _
City Zip Tela
Fflac>D►i.1an1-22399 714-7 7-8704
State Lic. City
& Classif. 45$493 Lic. # `1362 _ Sq. Ft. No. No. Dw.
Arch., Engr:, Size ' - • Stories - - Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address TeL
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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. 7031.5,15lusiness and Professions Coda: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure. prior to its issuance also
requires the applicant for such pemmi to lie 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 Protessiors 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 civilpenally 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 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 thatsuchimprovements are not intended or offered for sale. 11, however, the building
or improvement •is sold within one year of completion, the owner -bolder will have the burden
of proving that he did not build or kmprove for the purpose of sale.)
❑-li 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 krlproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exernpt under Sec. a_ & 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. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the pend 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: ff, after making this Certificate of Exemption you should become
subject to the Workers' Carpersation provisions of the Labor Code, you must forthwith
comply with such provisions or this perm shag 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 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 laves 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
stimated Valuation
$3.000
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
95 4.00
Mech.
Electrical
INSPECTOR
Plumbing
Date 11/14`89 Permit
S.M.I.
1
Grading
Validation:
Driveway Enc.
Infrastructure
TOTAL
554.21 _� l • L f
REMARKS
i0";w'C► i 1 ” MAVI ..--�1`4>r:.1
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 11/14`89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
BONDING
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. ®
FORMS
SEWER OR SEPTIC TANK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CARP. SQ. FT.
GAS (ROUGH)
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
OTHER APPIEQUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GROUT
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL -
FURNACE UNIT WALL FLOOR SUSPENDED
WATER SYSTEM
LAUNDRYTRAY
AIR HANDLING UNIT CFM
1KITCHEN 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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.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
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
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
FINAL INSP.
ROOFING
/n `
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
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199 KANESHIRO, INC.
ARCHITECTURE PLANNING
SITERLAN HEMEf, CA 92344 (7141
NOV 0 9 1989
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