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05775 (SFD)4 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 2u--715. V= ETA DRIVE LA QUINTA, CALIFORNIA 92253 Owner Address 74-925 HOMY #130 City Zip Tel. PALK DE92260 346-9174 . _ Contractor Address City State Lic. City & Classif. 5 5699 Lic. # Arch., Engr., Designer Address' Tel. City Zip State Lic. If LICENSED CONTRACTOR'S DECLARATION I 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 fofc/e and effect. SIGNATURE / p -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 issuance also requires the applicant for such pencil to file a sngned statement that he is licensed pursuant to the provisions of the conbactors 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 pennall, or not more than five hundred dollars (5500). ❑ 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 himseff or through his own employees, provided that such improvements are not Wended or offered for sale. O, however, the building or improvement is said within one year or completion, the owner-buflder will have the burden of proving that he did not build or improve for the purpose of safe.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project (Sec. -7044, Bastness and Professions Code: The Contractor's License Law does not apply to an owner of property who buftft 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. R. & P.C. for this reason Date Owner WORKERS COMPENSATION DECLARATION 1 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. Corrpanyi1v i:J%6"!f:.. fy'.i is, l:.'':s�` 'Yfis Copy is filed with 16 the city. ❑Certified copy is hereby furnished. f' ' CERTIFICATE OF EXEMPTION FROM - a 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, I shall not employ any person in any manner ao as to become subject to the Workers' Compensation Laws of California Date Owner NOTICE TO APPLICANT.ff, after arnafdrng 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 Otis permit shall be,deemed revoked. CONSTISICTION LENDING AGENCY I hereby affirm that there is a•©nstruction 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 priperty filled out, signed and validated, and is subject to. expiration if work thereunder is suspended for 180 days. I car ity that I have read this applcation 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 pn_rposes. Signature of applicant Date Mailing Address City, State, Zip No. 05775 WING: TYPE CONST: OCC: GRP. P. Number Description LOT .164 Project Description S.F.D Sq. Ft. 1220 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ . Repair ❑ Demolition ❑ 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 5/18/89 Issued by: Date Permit Validated by: Validation: Estimated Valuations%x445. g PERMIT AMOUNT Plan Chk. Dep..;€}-.{ Plan Chk. Bal. 271.15 Const. 495.50 t; Mech. 60.00 Electrical 86.94 ; Plumbing 120.50 S.M.I. 4.76 l . Grading Driveway Enc. Infrastructure . 1,5:7.51 " TOTAL $2,706.36 C-1, , V - REMARKS 'L 51,S2 MW 5.16 rr'Tv )`12f -IIA I -M It: 10 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 5/18/89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE Ofmoi ® 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. Z 2% c POWER OUTLET ROOF DRAINS GAR. SO. FT. ® HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL DRAINAGE PIPING CAR P. SO. FT. ® GROUT DRINKING FOUNTAIN. WALL SQ. FT. FINAL INSP. BOND BEAM URINAL SO. FT. @ GRADING cu. yd. $ plus x$ =$ ESTIMATED CONSTRUCTION VALUATION $ FRAMING (V7--7 FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation �v FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOxDISH) APPLIANCE DRYER 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Vi c SEWAGE DISPOSAL SQ.FT.GAR ® Vic 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 SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE Ofmoi ® ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. Z 2% c AS (ROUGH) Gav _ ER 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 GR. FINAL INSP. ?f �y Q FRAMING (V7--7 FINAL INSP. ROOFING It c7 Q VENTILATION FIRE ZONE ROOFING : FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND f GRADING FINAL INSPECTION, CERT. OCC. D /FINISH �v REMARKS: SIGNATURESIINITIALS GARDEN WALL FINAL