05258 (SFD)P.O. BOX 1504
Building 7&105 CALLE ESTADO
Address 48-130 Via Rermasa R, LA QUINTA, CALIFORNIA 92253.
Owner
Mailing
Address ^
City Zip Tel.
_L
�•1ti A
Contractor'
James Cash aaa`Starling Cora.
Address
77-.WAA 1N 4""fte ^il-A
A.vf.. n ..... cIff '� . C
State Lic. City '
& Classif. 103333 Lic. #
Arch.; Engr.,
Designer
Address Tel.
City(Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I 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 affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.8usiness and Professions Code: Any city or county which requires a
permit to construct, after, 6rmrove, denpffsh, or repair any structure, prior to its issuance also,
requires the applicant for such permit to Me a signed statement that he is licensed 1pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professians 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
Prolessions Code: The Contractor's License Law does not apply to an owner of property who
builds oi'impmves' thereon and who does such work himself or through his own employees,
provided that such bnprovements 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 erprove 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 brproves thereon, and who contracts for
such projects with a contractors) 6oensed pursuard to the Contractor's License Law.)
❑ 1 am exempt under Sec. a- & 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, ora 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 B the permit 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 APPLICANT 8, after malting 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 the permit shag, 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, Civr7 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
No. a •258
BUILDING: -TYPE CONST. OCC: GRP.
A.P.+Number
Legal Description
Project Description' T)11_'_ 1;9
I.Sq. Ft. i 01, '`
K n • �w +
No. No. Dw.
Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑
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
FINAL DATE
INSPECTOR
Estimated Valuation
$103,145
Date Permit
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
S
363.22
Const.
441.00
Mech.
39.. v0
Electrical
68.87
Plumbing
98.00
S.M.I.
7.25
Grading
Driveway Enc.
Infrastructure
2,320.76
Fringe -Teed
I.iznad.'
431.06
TOTAL
$3.476.16
1/
REMARKS
4,'.1ri. ,/"z
41 iS...00 i 4
y�4.ytyi �'stf [.fby.:
.t �..+.n 1..•�iV f# fi 1. 1f�t'ji-�
?. _ ,.c�-T iiJ 4.:x.
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
12/30/88
Issued by: '
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
/((
RADE)' —/ �7
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
R OR SE IE7/l
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
AS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) ��
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
FINAL INSP.
URINAL
SQ FT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
ROOFING C�
VENTILATION
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
IGARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
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
INSULATION/SOUND 7f// e
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
TNST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
S CK
ND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
/((
RADE)' —/ �7
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
R OR SE IE7/l
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. ST L
GAS (FINAL) ��
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING /
ROOFING C�
VENTILATION
j
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
/
LATHING
MESH
INSULATION/SOUND 7f// e
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITU►LS
GARDEN WALL FINAL
1