05958 (SFD)Building
Address 7$-748 Via Sonata_
Owner
B3rCOr't Dei.
Mailing
Address 68-713 Perez Rd. # 1
City lZip
CAt City 1 92234 1 773
Contractor
ress
Tel.:
V.
4,4 a"..
P.O. BOX 1504 N o .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: •TYPE CONST. OCC: GRP.
A.P. Number
State Lic. City
& Classif. 337077 Lic. # 1219„ ,
Arcn., tngr.,
Designer
Address
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 o/f the B mess and Prof ions Code, and my license is in full force and
effect. �
_SIGNATURE [- ,I"`•' - 9 DATE
OWNER-BUILDER DECLARATION"
_ I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,11usiness and professions Code: Any city or county which requires a
Permit to construct, after, improve, 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 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 penally of not more than five hundred dollars ($500).
❑ 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
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
or improvement 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 contractors) 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 1 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
aliforniaDateowner
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.)
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
05958
Legal Description SSC III LOt 19
Project Description plait 1804 fare La. f31ntnta,
REMARKS - ..i�
.T_. f«�,s�x-
;ss 6:� . V is
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 6-16-84 Permit
Validated by:
Validation:
Sq,Ft. 1i4
Size
No. No. Dw.
Stories Units
New Add ❑ •
Alter ❑ Repair ❑ "Demolition ❑
Estimated Valuation
3'b04• 00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
i •
Const.
=S
Mech.
5` •
Electrical
- - 106.56
Plumbing
13B..
S.M.I.
9
Grading
Driveway Enc.
Infrastructure•
TOTAL
53� Ct �, ItY.
REMARKS - ..i�
.T_. f«�,s�x-
;ss 6:� . V is
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 6-16-84 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE 41/9(16Q
ROUGH PLUMB. X
YARD SPKLR SYSTEM
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF. G %�
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CARP. SO. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN.
WALL SO. FT.
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SO. FT.
GRADING
-...yd.
-Plus-X$-=$
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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 ® 1% c
SEWAGE DISPOSAL
FINISH GRADING
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 ELECTRICAL HEATING & AIR COND. SOLAR
�n-�,-a--rt�+c
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 41/9(16Q
ROUGH PLUMB. X
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. G %�
(ROUGH) / . �J a
O� �a
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.
FINAL INSP
/
F�iAMING
1
FINAL INSP.
ROOFING
VENTILATION
REMARKS:
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
6LATHINC? - a
MESH
L, INSULATIONISOUND 2
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL