06988 (AR)Building
A.4.4-78-252 Hacienda
Leon
Mailing
Address
City
La au"
Contractor
T4t,yl 4 4 Qm
P.O. BOX 1504
78-105 CALLE ESTADO -
LA QUINTA, CALIFORNIA 92253
92253 1
72-677 Beavertail
& Classif- 5218913 I L'ic. #
Arch:, Engr.,
Address' I Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of chapter 9 (commencing with Section
700W of Division 9 of.the B isiness and Professions.Code and my license is in full force and
effect
SIGNATURE - DATE
OWHER—WILDER DMLARATK)N
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reasorr (Sec. 7031.5;Bushose and Pimfessims Code: Any CO or county whkh reqs: a
pemdt to construct. ager, Nfprove, demolish, or repair any structure, Priv to Ns Jss+rwrce also
rerpdres,ane"appBcant for such panni to fib a signed statement that he As Bcensed pursuant to
ale p+ovlsforrs w rhe Canbactor§ Lomas Law. Chapter 9 (aomnwncbng with Section 7000) of
ADtslan 3 of We Business and Profeaslarra Code" or that. he Is axen W therefrom, and the basis'
for Me a9eged eYerrWion: Any vfotafWir o/ Section 7031.5 by any applicant for a pent
e jecta Me,eppi9cent foa clva penalty of not more Men five hundred dagars (5500).
❑ 1, 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„ Buftness and
Professions, Cade: The Contractor's Lkense Law does' not: apply to an owner of prgpenty who
breads or irproves thereon and who does such wort Iurrsefl or through his own anpbyees;
prodded Ma( suds kwovemerts ere not hteadad or offered for safe. h however, Me bxdkffW
a Npnovamernt IS sold- wlthtr one year of ce+npfsfionr, the owner -budder rrm have the burden
of provhV that he did not: brdd or k prove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed_ contractors to con-
struct
struct the project. (sec. 7044; Business and Professims•Code: The Contactors Lrcense paw
does rnet apply•fo an owner of property who bukIs or'tmproves theism, and who contracts for
such pnojecta rah a contractors) tcansed pursuant to the Cont racGor s Lscense Law.) .
❑ 1 am exempt under Sem a. A P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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 E7I91PTION FROM
WORKERS' COMPENSATION INSURANCE
(Tft section, need not beconpfafed a the pemtt is for, one hundred d abra (:100) valuation '.
or Am.)
1 certify that pIn the performance of the work for which this permit is issued, I shall not
LerYecyof p iforrila in any manner so as to become subject to the Workers' Compensation
Data - Owner
NOTICE TO APPLICANT If, after # %M tMe Osraffeete of B:xamptim you dioukf became
ad0ect to Me Workers' Cmpensamon proftics of the Labor Code. you must foAhw/M
campy walk such Provisions or this permit --shad be deemed revoked.
CONSTRUCTION LENDING AGENCY.
I. hereby afffrml that there is a construction, landing agency for the performance: of the
work for which this permit Is Issued. (Sec. 9097. Chi Code:)
Ladders Nene
Lenders Adder'
This Is'a building permit whenWprooppeeAr1� filled out, signed and validated, and'is subject to
expiration If work UlereurWer is suspetwes for 18D days-.
I certify that I heve read` this-application,and state that the above information is correct:
1 agree to eomply with'all city and county ordinances and state laws relating to building
oxxxstoned n end hereby authorize, tepres-telrrea of this city to* enter the above--
msntkuoed property far irropection purposes.
Signature of applicant Date
Mailing, Address
City.- State, Zip
No. 06988
WING: TYPE CONST. OCC: GRP.•
P. Number Tar Quinta C0tuatlry C1n1%
gal Description
eject Description DiMnIn , No= aoxenslaf3
Sq. Ft. 27 No. No: Dw.
,Size Stories - Units
New ❑ Add ❑ Alter El Repair ❑ -Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. 929.25
Const.
Mech.,
Electrical
Plumbing
S.M.I. 5
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKSC.
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 2/7/90 Permit'
Validated by:
Validation-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO.. Fr. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR
DUCT WORK
Tv�
ROCK STORAGE
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. I SO. Fr. ®
TEMP. POLE
WALL SO. FT.
GROUT
DRINKING FOUNTAIN.
SO. FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
'
=$
FLOOR DRAIN
MECHANICAL FEES
FRAMING G �fjlf'
! v
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
REMARKS:.
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, TEMIPERM
LAVATORY
HEATING SYSTEMFORCED 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 @ 1Vi c
SEWAGE DISPOSAL
MESH
SO.FT:GAR ® 3'ic
HOUSE SEWER
INSULATION/SOUND 91+011,
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE [P!LCK.FEIE
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
Tv�
ROCK STORAGE
FOUND. REINF. yl �8
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
E plus xi
'
=$
LUMBER GR.
FRAMING G �fjlf'
! v
FINAL, INSP.
ROOFING
/
C
REMARKS:.
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND 91+011,
FINISH GRADING
I
FINAL INSPECTION &20
CERT: OCC,
FENCE FINAL
INSPECTOR'S SIONATURESIINRIALS
GARDEN WALL FINAL