05485 (SFD). •j
P.O. BOX 1504
Iding 78-105 CALLE ESTADO
Tress 48-147 Vista Cielo LA QUINTA, CALIFORNIA 92253
...... Abe & Thel= GYaamman
Mailing -'
Address 9010 Corbin Ave. S.3
City Zip Tel:
1 Nartbridge 91324 810/349-5894
C b ntractor
.Jams C. Cashman
Address
I 77-200 Minnesota
CityZip Tel.:
f alfa Desert 92259 a19/345-500
State Lic..�, City
&� Classif.. S 195333 Lic. # 2W
Arch.,•Engr.,
Designer..-
Address-
esigner.,.Address- Tel.
City Zip State
i Lic. #
i LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I 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 '/d,•r:, .'...�.'= .Ct✓.T a�lr',: •.'�'.'•'"/..�... •-, ter`, � �`
�anw�uHt - DATE
F OWNER -BUILDER DECLARATION'
i 1 hereby affirm that I am exempt from the Contractor's License Law for the following •
reason: (Sec. 7031.5,Buslness and Professions Code: Any city or county which requires a
permit to construct, alter, impiove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rite a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Dndsion 3 or 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 chd penalty ofnot 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 or 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-bullder will have the burden
or proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
structthe 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.)
❑}I am exempt under Sec B. & P.C. for this reason
r
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self-insure,or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Polity No Company
'j_o'Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
{ WORKERS' COMPENSATION INSURANCE
(Otis section' need not be completed IF the permit is for one hundred dollars (8100) valuation
ortess.)
i 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 making this Certificate of Exemption you should become
sWect 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
1 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 abuilding permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity that 1 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
1
No. 45485
(BUILDING: TYPE CONST. - OCC: GRP.
A.P. Number 617440-034
,Legal Description Lot 34
Project Description Plan 3
Sq. Ft. IS52 No. No. Dw.
Size Stories Units
New Add ❑ Alter ❑ Repair ❑ -Demolition ❑
stimated Valuation
$102,226.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
i '. ` 545-43
Const.
550.013
Mech.
66.50
Electrical
11 ,.72
Plumbing
-o
S.M.I.
!r1
Grading
Driveway Enc.
Infrastructure
i •
TOTAL
REMARKS
' �i V <.f 1.5�.Ki'i<J t � S• r u 9A#i f 7� :.Y .y2 + wry •v' i N ,i � e'J°i
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 3/14/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
$
UNITS•
SLAB GRADE Ll
IST FL. SQ. FT. ®
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
YARD SPKLR SYSTEM
2ND FL SQ. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
OTHER APPJEOUIP.
REIN F. STEEL
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
_$
URINAL
SQ FT ®
ROOFING !� ✓'
VENTILATION I �/
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
4uo
ESTIMATED CONSTRUCTION VALUATION $
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
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 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
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING i ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE Ll
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS(ROUGH)®... s[
GAS(ROUGH)/0 +
ETER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. STEEL
GAS (FINAL) `
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR. FINAL INSR
FRAMING % t I I f FINAL INSP. 1) i
0' O
ROOFING !� ✓'
VENTILATION I �/
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
4uo
REMARKS:
_
SIGNATURESIINITIALS
GARDEN WALL FINAL