05936 (SFD)P.O. BOX 1504 N o .
Building , ar Q�8 iOCIi 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Address 68-723 Perez Rd. # 2
City Zip Tel.
Cat City 92234 773-9424
Contractor
Address ..
Zip ITel. ;
State Lic. City
& Classif. 337077 Lic. # 1219
Arch:; Engr., -
Designer
Address' Tel.
City Zip . 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 Me Business aM 10 fessions Code, and my license is in/full force and
effect. r. r • tr-^" t C`/ 1' �� Ct�
SIGNATURE DATE
y4s OWNER BUILDER DECLARATION
'I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5.19 somess and Professions Code: Any city or county which requires a
permit to construct, after, brprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractors 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 civilpenally of not more than five hundred dollars (5500).
❑ 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, Ouisness and
Professions Code: The Contractors License Law does not apply to an owner of property who
but. 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 ani rove for the purpose of safe.)
❑ 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 contrac"s) 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- Co mpany
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKED' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) 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: ff, after malft this Certificate of Exemption you should become
subject to the workers' Compensation provisions of the Labor Code, you must forthwith
comply with such proi4siors or this pemnit 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.)
Lenders Name
Lenders 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 certity 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
059.36
BUILDING:. TYPE CONST. OCC: GRP.
A.P. Number
Legal Description Phase 11 Lot 15
Project Description , Plan 2740 Pare La 'uinta
S Ft.`. s'✓'
q.,, 1740 Stories
No. Dw.
Size - Stories Units
New. Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation 58,594.04
PERMIT �� r1� AMOUNT
Plan Chk! Dep.
BY:
Plan Chk. Bal.
ti 414•
Const.
•
Mech.
n a •
Electrical
•
Plumbing
S.M.I.
6• '
Grading
'
Driveway Enc.
Validated by:
Infrastructure
i992• 9
Validation:
TOTAL
3* ' o
REMARKS1riT"�r
!i 11 10
iV t..Ha)i ta'IR.. k't r1,1A14V
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
Issued by:
Date 5-16--89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL Sp. FT.
SLAB GRADE
YARD SPKLR SYSTEM
ROUGH PLUMB.
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
STORAGE TANK
FORMS
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT. ®
AS (ROUGH) _
METER LOOP
WALL Sp. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
Sp FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GROUT
FLOOR DRAIN
MECHANICAL FEES
SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
plus x$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FRAMING D / KNAL INSP.' `/ -•
[
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
Sp. FT. RESID ® IV4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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 � _�. S ELECTRICAL HEATING & AIR COND. SOLAR
cis
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. �'
AS (ROUGH) _
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR. FINAL INSP.
FRAMING D / KNAL INSP.' `/ -•
[
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING tOW
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
urc cru Ag
O��
filli'Aw
O
/IVryA(// /A,'•�
„-,
REMARKS:
IINSPECTOWS SIGNATURESANITIALS
GARDEN WALL FINAL