05928 (SFD)Building
Owner
Mailing
Address 68-713 Perez Rd. f 1 -
City lZip ITel.
Contractor
Address
4
P.O. BOX 1504 N o .
7&105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
05928
WILDING: TYPE CONST. OCC: GRP.-
t.P. Number
.egal Description Fuse 11 LAE 13
project Description Plan 2.004 Parc La Quinti,
State Lic. -
City
& Classif. 337077
Lic. # 1219
Sq. Ft. 2004
No. No. Dw.,
Size
Stories Units
Arch:, Engr.,
Designer :• •
Newer Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
' LICENSED CONTRACTOR'S DECLARATION
I here,y`affirm that I am licensed underlprovisions of Chapter 9 (commencing with Section
7000) of Division t Business
.of fess
3qq$nn.. mons Code, and my license is in full force and
L �- �
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, •�'�Nr / C �.• A?�4
SIGNATURE �� DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
1 hereby affi4n that 1 am exempt from the Contractor's License Law for the following
102,026.00
reason: (Sec. 7031.5,6;usiness and Professions Code: Any city or county which requires a
permit to construct• after, improve, demofsh, or repair any structure• prior to its issuance also
1^
requires the applicant for such permit to tole a signed statement that he is licensed pursuant to
PERMIT
AMOUNT
• the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/
•
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for alleged exemption. Any violation Section 7031.5 by 'any for
Plan Chk. Dep. -
..
.the of applicant a permit .
subjects the applicant to a chid penalty o/ not more than Owe hundred dollars (5500).
..
Plan Chk. Bal..
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❑ 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, Buisness and
Const.
�� '•
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who dues such work himself or through his own employees, •
Mech.
13.00
Provided that such knprovemenM aro not intended or offered for sale. If, however, the budding
*-
or improvement IS sold within are year of completion, the owner -budder will have the burden
Electrical -
-'�'r` 3• 30
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-
Plumbing
•
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 /or
S.M.I.
•
such projects with a contractw(s) 8censed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec" w• & P.C. for this reason
Driveway Enc.
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
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 ff 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 - Owner
NOTICE TO APPLICANT: if, after malft this Certificate of Exemption you should become ZONE: BY: '
subject to the Workers' Compensation provisions of the Labor Code• you must forthwith
comply with such Provisions or this permit shag be deemed revoked. - Minimum Setback Distances:
Front S tb k f C t I
Infrastructure 2 5.• '�
TOTALsa"ri r� '
REMARKS P;ik�ii"fa'`,.�J 'f<1r7H-fA�;:v# z'x>hr r
;1, 4t "v �'jw.)Y A yt.�-Yt�.� .,a u4wc., ..-s•.r.✓ '
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, Ciel 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 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
e ac Tom en err Ine
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued•by: Date 6-16-89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE 7 w
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROCK STORAGE
nSEWER
FOUND. REINF. 7 Z� 1��
!!!///
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. I SQ. FT. ®
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN.
WATER HEATER
SERVICE
URINAL
SO. FT. ®
BOND BEAM
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FRAMING /Q /.� j%9AVY
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR ® 3/ec
HOUSE SEWER
-
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEECONST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 7 w
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
OR SEPTIC TANK ROUGH WIRING.
DUCT WORK
ROCK STORAGE
nSEWER
FOUND. REINF. 7 Z� 1��
!!!///
GAS (ROUGH) —22
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 GFL
FINAL INSP/
FRAMING /Q /.� j%9AVY
FINAL INSP.
ROOFING
�v
04
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING QWA/
MESH
INSULATIONISOUND ®/ O
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL