06270 (BLCK)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 46-200 Roadrunner LA QUINTA, CALIFORNIA 92253
Owner
Howard
Address -•RI %[liX
City
. Bermda Dunes
Contractor
Cherokee
Address
79-811 Cou
City
lie gtuda Dunes
State Lic. 4'7407
& Classif.
Arch., Engr.,
Designer
Address
v n'h
Zip Tel.
92201 . e
No. 06274
IUILDING: TYPE CONST. OCC: GRP.:
,.P. Number 617--112-011
•. < .w
egal Description
Project Description Block Mall 200' X69 high_
Y Club
Tel.
92201 345.6225 -
City
Lic. # "�� Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel.
City Zip State
Lic. #
LICENSED CONTRACTORS DECLARATION
1 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 aftipn Mat I am exempt from the Contractor's License Law for the following
reasor: (See. 7o31.5,13usfness and Prolassrons Code: Any city or county which requires a
permit to construct. ater, irprove, demolish. or repair any structure, prior to its issuance also
requires the appicard for such pemuT to Me a signed statement that he is licensed pursuant to
the provisions of the Cmbactor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Brsliress and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption- Any vioktion of Section 7031.5 by *any applicant for a permit
subjects the appfcant to a civt penally of Trot more than 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 Contractor's License Law does not apply to an owner of property who
bulli& of irproves thereon and who does such work himself or through his own employees,
provided that such mirovenerls are not intended or offered for safe. If, however, the building
or urprovenent is said wdRir one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of safe.)
❑ 1, 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 appy to an owner of property who builds or improves thereon, and who contracts for
such projects with a cerdracior(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
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 furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(rhis section need not be conpreted If the pemrit is for one hundred dollars ($100) valuation
or less:)
I certify that in the performance 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 APPL)CANT: f, after malting this Certificate of Exemption you should become
subject to the Workers' Compensation provisias of the tabor Code, you must forthwith
comply nth such Provisions of this permit shag 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, Crow Code.)
Lender's Name
Lenders Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days. '
I 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 sof this city to enter the above..
mentioned property for inspection purposes
Signature of applicant Date
Mailing Addre4�
City, State; Zip
stimated Valuation $51000
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. $72.00
Mech.
Electrical
Plumbing
S.M.I. .35
Grading
Driveway Enc.
Infrastructure
TOTAL / ,4
REMARKS 'r - r. n .n r.>- tixti -3n-01)-- _. %A
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
9/1.2/89
Issued by: Date 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 S0. FT.
/!
C-9RIo s. /"/ �" G�' X21
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. S0. FT, ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. S0. FT. ®
GROUT
WATER HEATER
WALL S0. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM��
TER SYSTEM
URINAL
SO. FT. ®
_$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
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
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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+/s c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ec
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
/!
C-9RIo s. /"/ �" G�' X21
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK.
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM��
TER 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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL