05259 (SFD)Building
Address
Address 9010 Corb,
City Zip
Contractor
Address
T4,Yl 4 4 a"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City _ _ _ Fri -p— .,__ _ _ Tel. -
Palm 1 92260 345-5430
State Lic. City
& Classif. 193333 Lic. #
Arch., Engr.,
Designer
Address I Tel.
City(Zip I
State
Lic. #
LICENSED CONTRACTORS DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
effect. Division 3 of the Business and Professions Code, and my license is in full force and
effec
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.6siess and Professions Lode: Any city or county which requires a
permit to construct, alter, improve, demoFsh, or repair any Structure, prior to its issuance also
requires the appicad for such permit to Me a signed statement that he is licensed pursuant to
the provisions of the Contiarxors 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 vbbtbn of Section 7031.5 by 'any applicant for a permit _
subjects the appirdnt io a cir7 penally of rpt more than five hundred dollars (8500).
❑ 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, euisness and
Protessherhs Code: The Cordracors License Law does not apply to an owner of properly who
builds or improves 0rerpm and who does such work himself or through his own employees,
provided that such krprovements are not intended or offered for sale. If, however, the building
Of inproyement is sold within am year of completion, the owner -builder will have the burden
Of proving that he did not build or irpvove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec- 7044, Bus -chess and Professions Code: The Contractor's License Law
does not apply to art owner of property who builds or improves thereon, and who contracts for
such projects wO a contractor(s) ioensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec w_ & P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workees 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
(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 thy 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 Califomia.
Date Owner
NOTICE TO APPLICANT: 8, after making this Certificate of Exemption you should become
subject to the Workers' Conre nation provisions of the Labor Code, you must forthwith
uxxnply rich such provisions or this permit shW 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, Chfl Code.)
Lender's, Name
Lender's 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 car ity 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. 05259
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number 7feLcE2.-f}?3
Legal Description
Project Description 19
Sq. Ft. No. No. Dw.
Size a. Stories Units.
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
I
Estimated Valuation
$103,145
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 368.22
Const.
443.00
Mech.
39.0€1
Electrical
68.87
Plumbing
98..00
S.M.I. -
7.25
Grading
12/30/88
Driveway Enc.
Date Permit
Infrastructure
2,.320.76
, ringe—Taped lr zaa>rd
131,06
TOTAL $3,476.16
REMARKS
.ice` �fi J: �i :V �Y 1tith:. I .y"tt4i•.L'i:h
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
f
Side Setback
om Property,Line
FINAL DATE
INSPECTOR
12/30/88
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
GRADE 3-60
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
WER OR
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH
07
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) f�
_ P. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER 000,
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO FT ®
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FR;ZING
WATER PIPING
NOTE: Not to be used as property tax valuation
. A
/
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR ® 3/ic
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
GRADE 3-60
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
WER OR
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH
07
METER LOOP
HEATING (FINAL)
OTHER APPJEOU1P.
REINF. STE
GAS (FINAL) f�
_ P. POLE
GROUT
WATER HEATER 000,
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP f%
FR;ZING
FINAL INSP.
RO ING
. A
/
REMARKS:
VENTILATI
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�y��yJJ
LATHING PIV ' 7 � �cC
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL