06450 (SFD)T el 0
4tyl 4 4 a"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 44-425 Foatal~il Circle LA QUINTA, CALIFORNIA 92253
Owner
Le Quinta Associates
Mailing
Address 43—$75 Washington St.
City Zip Tel.
Palm Desert 92260 345-7541
Contractor
E. G. Williams Dev. Corp.
City
State Lic. City
& Classif. 493919 Lic. # 1232
Arch., Engr.,
Designer
Address
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I 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,Busi7ess and Professions Code: Any city or county which requires a
permit to construct, after, krprove, demoBh. or repair any structure, prior to its issuance also
requires the applicant for such permit to Me a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the affeged exemption. Any vkolafion of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenalty ofnot more than two 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, Suisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or knproves thereon and who does such work himself or through his own employees,
provided that such Iprovements 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 buil or krprove for the purpose or 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 property 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. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need net be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the perfonrance 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 ma0v this Certificate of Exemption you should become
subject to the Workers' Compensatim provisions of the Labor Code, you must forthwith
comply with such provisions or this Permft sha8 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
Lenders 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 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
No. 06450
11LDING: TYPE CONST. OCC: GRP.
P. Number Tr'aCt 22982 Fuse 115
I Description
Description
Plait 2C Lot 84
r
Sq. Ft. 1621
Size'
No. No. Dw.
• Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$87,514
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
S 48.77
Const.
583.50
Mech.
53.50
Electrical
104.00
Plumbing
123.00
S.M.I.
5.16
Grading
Driveway Enc.
Infrastructure
19969.07
TOTAL
$3,330.00 J'
REMARKS
r000.r.r- *' tr �
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
10/3/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
UGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
DUCT WORK
ROCK STORAGE
FOUND. REINF. Z(f (CV#'1?daoy
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL) 7Z5?MP. POLE
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER 1101 10, SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. I SQ. FT.
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
WALL SQ. FT.
LUMBER G d AL INSP3 f%b
7
DRINKING FOUNTAIN,
SQ FT ®
2 moi, ice(
(�t%
URINAL
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
OBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING , e ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBI G UNDERGROUND
A.C. UNIT
LOLL. AREA
SLAB GRADE (,2 C07,
UGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. Z(f (CV#'1?daoy
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
REINF. STEEL
GAS (FINAL) 7Z5?MP. POLE
GROUT
WATER HEATER 1101 10, SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER G d AL INSP3 f%b
7
FRAM G ( FINAL INSP.
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND Z�-7
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FFNf:F FINAI
2 moi, ice(
(�t%
REMARKS:
SIGNATURES11NITIALS
GARDEN WALL FINAL