05190 (SFD)T a 0
4t�/ 4 4Qw
Building
Address 44-120 Dalen Circle
Owner
tal OuiAta Associates
Mailing
Address Rt
City lZip ITel.
Contractor
Tela
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic. I City
& Classif. 493919 Lic. # 1231
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
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 Contractor's License Law for the following
reason: (Sec. 7031.5,BUSOess and WdeSSbns code: Any city or county which requires a
permit to construct, after, inprove, demolish. or repair any structure, prior to its issuance also
requires the applicant for such Penn& to fibs a signed statement that he is licensed pursuant to
the provisions of the Conbactor's License Law, Chapter 9 (commencing with Section 7000) of
&Wsion 3 of the Business and Profession Code, or that. he is exempt therefrom, and the basis
for the alleged exemption- Any violAbn of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penafy of nor more than five hundred dollars ($500).
❑ I, as owner of the properly, or my employees with wages as their sole compensation, will
do the work, and the stricture is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Conba toes License Law does not apply to an owner of property who
builds or rrproves thereon and afro roes such work himself or through his own employees,
provided that such improvements are not idended or offered or sale. If, however, the building
or Improvement is sold wrthiu one year of conpletien, the owner-bugder will have the burden
of proving that he did not build or irprove for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project- (Sea 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who buJds or improves thereon, and who contracts for
such projects with a contracair(s) 6ce used pursued to the Contractor's License Law.)
❑ 1 am exempt under Sec R_ & P.C. for this reason
Date
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
,,O''Copy is filed with the city_ ❑ Certified copy is hereby furnished.
CERr1FICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it his permits or one hundred dollars ($100) valuation
or less.)
I certify that in the performance of UV 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 maldng 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 d* pemd shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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 abuilding 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 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
ateMailing Address
City, State, Zip
BUILDING: TYPE CONST
No.
OCC: GRP.:
Number Chet"" Planter
Legal Description
05190
Description 'VUaats, T- 'Dl v%" i R _ T.<sf 17
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
12/29/88
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft. 1336
Size'
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$73.279
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 298.94
Const.
355.00
Mech.
53.00
Electri'c'%, ` ,.
65 .44
Plumbing
82,00
S.M.I.
5.15
Grading
Driveway Enc.
Infrastructure
1,648.78
TOTAL
S2.489.91
REMARKS
t°054A17 40
I w-iari
t Mirt). x :..•+ais..�a
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
12/29/88
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS '•
COLL. AREA
SLAB GRADE
j a7� 9
YARD SPKLR SYSTEM
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO, FT, ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL) CP7% OfTEMP.
WALL SO. FT.
DRINKING FOUNTAIN.
GROUT
URINAL
SO FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
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
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
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B,T.U.
SO. FT. RESID ® 11/4 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
WATER SYSTEM
ROUND PLUMBING —/
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
j a7� 9
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
MAI
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
�r
or
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) CP7% OfTEMP.
POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING / 1h
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
MAI
SPARK ARRESTOR
GAR. FIREWALL
MESH
INSULATION/SOUND 7t
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
GRADING
cu.
yd.
plus x$ =$
REMARKS: