05960 (SFD)Building 78-725 Vita Sowta
Address
Owner
Mailing
Address
City
Contractor
Address
State Lic.
& Classif. 33'7077
Arch., Engr.,
Designer}--
` Address
City
Zip ITel.
4
P.O. BOX 1504 No.
78-105 CALLE ESTADO
.LA,QUINTA, CALIFORNIA 92253
"-BUILDING: TYPE CONST. OCC: GRP.
Tel.:
City
Lic. # 1215
Tel.
State
Lic. #
r r
;per. LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
2000) of Division(g of the g\usiness an Proff&Aions Code, and my license is in fulll I.prgej and
41 -effect. 1_ - '° ^ ams Z
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, Improve, demolish, or repair any structure, prior to its issuancealso
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 rive hundred dollars ($500).
❑ 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
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
orimprovement 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 contractor(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
Workers 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 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, 1 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 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.)
Lenders Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 160 days.
1 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
wnstruction, 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
A.P. Number
05960
Legal Description Phase
Project Description
°r1l IAL
matt 1740
22
Pare- TA Ouinta
Distances:.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Sq. Ft. 1730
Size
No.
Stories
No. Dw.
Units
Newer Add ❑
Alter ❑
Repair ❑ -Demolition ❑
Issued by:
Date 6-10-89 Permit -
.Validated by:
Validation:
Estimated Valuation.
y
4.00
PERMIT
AMOUNT
Plan Chk. Dep. '
Plan Chk. Bal.
494.Z,5
Const.
59u..
Mech.
6b.50
Electrical
•102, 0
Plumbing
120.«50
S.M.I.
Grading
Driveway Enc.
Infrastructure
1992.92
TOTAL
1 3373.00
25."y/657 CY:='j.
REMARKS nncr> .sr- ..._�..?ar .'1—
ZONE:
.a *
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 6-10-89 Permit -
.Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
N
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SQ. FT.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
SEWER OR SEPTIC TANK
ROUGH WIRING,
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
OU 2H?— ��
METER LOOP
DRAINAGE PIPING
CAR P. SQ. FT. @
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN.
WALL SQ. FT.
GROUT
WATER HEATER
URINAL
SQ. FT. @
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
$
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER. SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
/�
vim!
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
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
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE 7NST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIN �2/
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
�j
ROUGH PLUMB. -
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF.6�
OU 2H?— ��
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
yd.
plus x$
-$
LUMBER GR.
4NAL INS!302�,2,��cu.
FRAMING ////7/91 / / L,10
FINAL INSP.
ROOFING
VENTILATION
/O D
/�
vim!
��
REMARKS:
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
4ATHING —M
MESH
SULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL