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07605 (SFD)P.O. BOX 1504 N o . Building 78-105 CALLE ESTADO Address 48-548 Via Encanto LA QUINTA, CALIFORNIA 92253 Owner I M* & Thelma 6r osswn Mailing 9p%8 Corbin Avenue, S-3 City Zip Tel. Northridge I 91324 1 $18-349-5894 Contractor gegal Vis, Inc. Address 3184 Airway Avenue City Zip Tel.: Costa Mesa 92625 345-5430 State Lic. City & Classif. 1 446587 Lic. # 1566 Arch., Engr.,. Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70 OO) 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 affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business 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 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 'any applicant for a permit subjects the applicant to a civil penalty of not 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 - 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 -builder 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 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 Worker's Compensation Insurance; or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (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, Ishall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT:.If, after 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. CCC: GRP.: OT605 A.P. Number Legal Description Tract 20052-.5 0-1 an 4S Project Description Lacuna, de L Paz Lot 34 Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ z� ,timated Valuation $96,142 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. q-22 ru Const. tm Mech. Electrical 107.28 Plumbing 13 S.M.I. 115 ,79 Grading Driveway Enc. Infrastructure _. 2,163.19 .t TOTAL $3.618.30 REMARKSsaasrn�t ZONE: BY: Minimum Setback Distances: Front. Setback fro n Center Line Rear Setback fron Rear Prop. Line Side Street Setbatik from Center Line Side Setback frons Property Line FINAL DATE INSPECTOR Issued by: Date 4/19/90Permit Validated by: Validation:_ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SQ, FT. ® CAR P. SQ. FT. WALL SQ. FT. SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER IAS (ROUGHV0`JO L GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL Aj SQ.FT.GAR ® 34c HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEET SMI FEE PLUMB. FEE I STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLU p%. UNDERGROUND A.C. UNIT LOLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS EWER OR SEPTI I ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. — Ir IAS (ROUGHV0`JO L METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. Y&NAL INSP. IN' -e? ////�� /&RAMING r^l 1/-e/) t v FINAL INSP. D�jROOFING J�• Aj REMARKS:- EMARKS:VENTILATION VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL O)tLATHING01 -,12- MESH SULATION/SOUN V FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Bin # City a Q of uinta Building 8r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 8 _ syeAleq N 7-o Owner's Name: X A. P. Number: Address: Legal Description: _y. City, ST, Zip: K C Contractor:OL,/A)6/2; a v � � � :Address: T1 e e hone: P Project Description: X City, ST, Zip: Telephone: hone: X i State Lic. # : X, City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: hone: '• Construction on TYP e: Occupancy: cu P ancv. State Lic. #• Project type (circle one): : N ew Add' n Alter Repair air Dem p o Name of Contact Person: X I Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd. TRACKING PERMIT FEES aPlan Sets Plan Check submitted vv 5120 Item Amount Structural Calcs. Reviewed, ready for corrections Z Plan Check Deposit Truss Calcs. Called Contact Person (d 02 Plan Check Balance Title 24 Calcs. Plans picked up ski Consts uction Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''d Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.Pp, Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees f (R4 5�r 8