07329 (SFD)P.O. BOX 1504
Building 44-00 Via Oe! Sol 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Dearte times
AddressH Augusta Dr.
City Zip Tel.
Rancho M3ralge 92270 321-€004
Contractor
Address
City
State Lic. (City
& Classif. r1A1l02An Lic. #
Arch-, Engr-,
Designer
Address Tel.
City Zip State
Lic. #
11 LICENSED CONTRACTOR'S DECLARATION
I herebyy;affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of,Division 3 of the'BusiinbSs arnd _Professions Code, and my license is in full force and
+�
SIGNATURE 1 DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 -may applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars (S500).
❑ 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
_Prolessions 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
orimprovement 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.)
O 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Go mpg sat-ntl*rtsyra fora cert(fi! ycopyit e[eof. (Sec. 3800, labor Code.)
Policy Noir ii ff`fl Company 1S ee�ti33 iFl
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE i.
(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 California-
Date
aliforniaDate Owner /
NOTICE TO APPLICANT: d, 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 shaft be deemed revoked.
ji .
CONSTRUCTION LENDING AGENCY
Ihereby 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 }
Lenders Address t
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. '
1 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. 07329
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number 613-402-004s 009, 010
Legal Description TT -23971 Lot A - -
Project'Description
Sq. Ft. 27100 No. No. Dw.
Size Stories Units -
New ❑ Add ❑ Alter ❑ " Bair ❑ Demolition ❑
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
Estimated Valuation
$134,038
PERMIT
Issued by:
AMOUNT
Plan Chk. Dep.
'
Plan Chk. Bal.
Const.
"3Gi1J"00
Mech.
.til •`_��
Electrical
�d•:3
Plumbing
18
135.9
S.M.I.
• 0
Grading
9 4 1
Driveway Enc.
Infrastructure:•
TOTAL
*4,758.37
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
3%13/90
Issued by:
Date Permit
Validated by:
Validation:. ��
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES }\
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADES 4
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMSER
OR SE
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
S (ROUGH)
METER LOOP
GAR. SO. Fr. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SQ FT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP. O ?011 0
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
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
- POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
STRUCTURE PLUMBING ELECTRICAL - HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBIN o10
UNDERGROUND " *
A.C. UNIT
COLL. AREA
SLAB GRADES 4
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSER
OR SE
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. 3 Q 9191/
S (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL 3 n
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. O ?011 0
FRAMING I
FINAL INSP.
ROOFING Q �/
s
Dy/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL