06474 (SFD)Building
Owner
T4ht
P.O. BOX 1504
44-305 Foxtail Circle LA QUINTA, CALIFORNIA 92253
Mailing
Address 43-575 Wasbiagtou St.
City Zip Tel.
Yale Desert 92260 1
345-7541
Contractor
B. G. Willis= Dev. Corp.
Address
ty
State Lic.I City
& Classif. 493919 Lic. # 1231
Arch., Engr.,
Designer
Address Tel.
City IZip I 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,Busimis aM Professions Cade: Any city or county which requires a
permit to construct, ager, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permil to dile a signed statement that he is licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions 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 (E500).
❑ 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 Contractors 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 irprovements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of corWetion, the owner -builder will have the burden
of proving that he did not build of irprove for the purpose of sale.)
❑ 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 properly who builds or improves thereon, and who contracts for
such projects with a contractor(s) 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CEATIFIC/1TE0
F 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 person in amanner so as to become subject to the Workers' Compensation
Laws of California.any
Date Owner
NOTICE TO APPLICANT: B, after mabg this Certificate of Exemption you should become
subject to the Workers' Carrpensatim provisions of the Labor Code, you must forthwith
comply with such provisions or this permit 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.)
Lenders Name
Lender's Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
1 certify 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
No. 06474
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number Tract . 22982 Phase III
Legal Description_
Project Description
Plan 5BR Lot 80
Sq. Ft. 2134 - No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $113.413
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 570.32
Const.
688.54
Mech.
53.50
Electrical
120.17
Plumbing
138,50
S.M.I.
7.93
Grading
Driveway Enc.
Infrastructure
2,551.7$
TOTAL
$4,130.76 '-//✓75. n
REMARKS ,)i '+t,2^_.{n 9'..::-..t+f !'i.'? if.
LV
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
10/4/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
/y
SLAB GRADE 1()('e o(el`C
ROUGH PLUMB. BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL SO. FT. @
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH) �� ETER LOOP
HEATING (FINAL)
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) (/� �c EMP. POLE
DRAINAGE PIPING
CAR P. SO. FT.
01
WATER HEATER SERVICE
WALL SO. FT.
DRINKING FOUNTAIN,
SO FT ®
WATER SYSTEM
FINAL INSP.
FINAL INSP.
l _i 6
URINAL
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE: Not to be used as property tax valuation
FIREPLACE
FLOOR DRAIN
MECHANICAL FEES
INSULATIONISOUND 2j �L�v
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
INSPECTOR'S SIGNATURES/INITIALS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GARDEN WALL FINAL
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 ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3lec
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
/y
SLAB GRADE 1()('e o(el`C
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. �Q
n
�m !Ir'1 y
f v
GAS (ROUGH) �� ETER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. STEEL
GAS (FINAL) (/� �c EMP. POLE
GROUT
01
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
l _i 6
GRADING
cu. yd.
$ —Plus—X$—=$
REMARKS:
LUMBER GR.
FRAMING i%
ROOFING t y(X0 !/
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWAL D
LATHING
MESH
INSULATIONISOUND 2j �L�v
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
)