04710 (SFD)y
- 0471A
P.O. BOX 1504
Building " , i2-425 f$$ethowr LA QUINTA, CAL FORNIA 92253
Address - _ .
Owner .,,
Mailing
Address .247 E. ' UhgU tz piny #2 w
City Zip Tel.
Palo. SprIngs 92262 9�2�-�O�t3
Contractor
Starr {:Q1Rtf3truetlon
Address
Sam
State Lic. 387934I City 895
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City( Zip ( 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.e.and
effect. 1_1 -
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,Susiness and Professions Code: Any city or county which requires a
permit to construct,' alter, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for, such permit to file a signed statement that he is licensed pursuant to
the provisions of the. Contractor's 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 of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O 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
Professlons'Code: The Contractor's 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 sale. If, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or Improve for the purpose of 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. 8 P.C. for this reason
Date Owner f
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent'to self4ure!or a certificate of
Worker's Compensation Insurance, or a certified copy; thereof: -(Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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 parson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall 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.)
Lender's Name
Lender's Address
This is a building permit when properly 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
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number • 773-X265-020
Legal Description
Project Description •��•
Sq. Ft. -, 1409 No. Y No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
If
1701 6'
(Estimated Valuation $461105
PERMIT
Plan Chk. Dep.°
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
AMOUNT
X64 » �FJ�.�,��
d Uri 9 V V
y
yyblI
74.1JUp�o1y
101.00
yye{ti * %�6
20RML
20•OU
REMARKS n�.s a trti ..r.. zl; ha_C1a t,7
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 10/21/88 Permit
Validated by:
Validation:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUIIDING, GOLDENROD • ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT rp ='
UNITS
//
& SLAB GRADE _ j -
ROUGH PLUMB BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
EWER OR SEPTI 1 X ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FTa
GAS (ROUGH) METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. a
GROUT
DRAINAGE PIPING
CAR P. 50 FT. a
FINAL INSP.
WALL SO. FT. a
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
plusxS=$
URINAL
SO FT fa
G —FINAL
INSP.
ESTIMATED CONSTRUCTION VALUATION S
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WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
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 C I'A c
SEWAGE DISPOSAL
SO.FT.GAR (g 3/4c
HOUSE SEWER
CERT. OCC.
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 8 AIR COND. SOLAR
ETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
//
& SLAB GRADE _ j -
ROUGH PLUMB BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPTI 1 X ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF,
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
S
GRADING
cu. yd.
plusxS=$
LUMBER GR.
FINAL INSP.
G —FINAL
INSP.
FRF1'NG - /
w
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
GAR. FIREWALL
p{
THING
MESH
66NSULATION/SOUND
FINISH GRADING
(, F NAL INSPECTION j`
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL