05356 (BLCK)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address SA—141n R Fd LA QUINTA, CALIFORNIA 92253
Owner "
CQAGHE LA.. 6AUEY LM
Address 247 E. TMQUIT2 #2
city
PALM
Tel.
PALMS�Z�1�S 92362 1 322--132(1.. ..:
Contractor
STARR CONSTRUCTION
Address.. `
SAM
City lZip Tel.: N "
State Lic. I City
& Classif. 337934 Lic. # $95
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7(!00) of Division 3 of the Business and Professions Code, and my license is in full force and
s
effect
SIGNATURE", - .- - ,. E•._-..... ,_ y.v I 1 DATE
a OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8uskhess arx! Professions Code: Any city or county which requires a
permit to cwhshuct, after, krprove, demolish, or repair any structure, prior to its issuance also
requires the appicant for such permit to Rhe a signed statement that he is licensed pursuant to
the provshorhs of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of this Dress and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any vatation of Section 7031.5 by 'any applicant for a permit
subjects the appicant to a civilpenalty of not more than rive hundred dollars ($500).
❑ 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,. Buisness and
Protessions Code. The Contractors License Law does not apply to an owner of property who
bwkfs or improves thereon and who does such .work himself or through his own employees,
provided flat' such krprovements 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 build or krprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the
ornstruct-the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not appy 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
r
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent`to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereoI.r(S 3'800, Labor Code.)
Policy No Company >W _ II /
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need no: be completed if the pemrit is for one hundred dollars (S 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 California
Date Owner
NOTICE TO APPLICANT: it. after makkhg this Certificate of Exemption you should become
subject to the workers' Compensation provisions of'the Labor Code, you must forthwith
comply with such provisions of Otis pemtit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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.)
Lender's 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 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 Address -_
City, State, Zip
No. 05356
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 77Lt-7.%1I_ _M7
Legal Description lgf- 1R t,%Itr 201 rvn4ff• 97
Project Description RETATNT1+?G WALL
ZONE:
BY:
Minimum Setback Distances:
Front. Setback from Center Line
Sq. Ft.
Size
No.
Stories
No. Dw.
� Units
New ❑ Add ❑
Alter ❑
Repair ❑ -Demolition ❑
FINAL DATE
INSPECTOR
Issued by;
Date 2114%89 Permit
Validated by:
Validation:
Estimated Valuation
2 *25-0
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
34 M
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
r
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 2114%89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO, PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. gp, FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL Sp. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SOFT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
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
VENTILATION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
`
BOND BEAM. �p
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINTTIALS
GARDEN WALL FINAL
)