06839 (SFD)T a 0
4ht 4 4 a"
Address 44-125 Goldenrod Circle
Owner
La Cuinta Associates
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 43-875 Washington St.
City Zip Tel.
Palm Desert 92256 1 345-7541
E.G. Williams Dev. Corp.
Zip I Tela
State Lic. City
a Classif. 493919 Lic. # 1231
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
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 Contractor's License law for the following
reason: (Sec. 7031.5.Buskiess and Professions Code: Any city or county which requires a
permit to construct, after, improve, demoksh, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that hes 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 or Section 7031.5 by 'any applicant for a permit
subjects the appiaard to a civil penally of not more "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 Contrachies 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 improvements are not intended or offered for safe. ff, however, the building
orimprovements said w»tivn one year of completion, the owner-buDder will have the burden
of proving that he did not build or improve 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 Contractors License Law
does not apply to an owner or property who bukis or knproves thereon, and who contracts for
such projects with a eontracAWS) ficensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec_ R. & P.C. for this reason
4) _
Date � V r Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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 fumished.
CERTIFICATE OF 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 any manner so as to become subject to the Workers' Compensation
Laws of Califomia
Date Owner
NOTICE TO APPLICANT: If, after malmg this Certificate of Exemption you should become
subject to the Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such Provisions or this pemtll shelf 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 abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180%;.
I certity 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 Address
City, State, Zip
No. 46839
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number Tract 22982 - Phase Ili
Legal Description
Project Description
Cactus Flower
Plan 58 - Lot 103
Sq. Ft. 2134
Size
No. No. Dw.
Stories Units
New ❑ Add 0
Alter O Repair ❑ Demolition O
Estimated Valuation113>,413
PERMIT
AMOUNT
Plan Chk. Dep.,
r,
Plan Chk. Bal.
W v .v6
„ ,�
Const.
r Is
Mech.
58
" •
•
Electrical
A
Plumbing
Si.
""""'
S.M.I.
""
Grading
Driveway Enc.
,.
Infrastructure
I,—) n
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
1/10/90
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB. °
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWER OR SEPTI Al Q
ROUGH WIRING J /6 Q
M0131LEHOME SVC.
BAR SINK
POR. g0_ FT, ®
GAS (ROUGH) / G
(O 7
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
FINAL INSP.
URINAL
SO FT ®
_$
-LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
ROOFING ll
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
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 a 3/ac
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.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 SEPTI Al Q
ROUGH WIRING J /6 Q
[( DUCT WORK
ROCK STORAGE
FOUND. REINF. SAS/A
(
GAS (ROUGH) / G
(O 7
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP. < C
GRADING
cu. yd.
$ plus x$
_$
-LUMBER GR.
j
FRAMING g✓/ �f1.L
ROOFING ll
/
REMARKS:
VENTILATION
FIRE ZONE .ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING i;IW
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL