06669 (SFD)T-iht 4 4 Q"
Building
Address 7&4 t5 Villeta Dr.
Owner
Address 74.923 .Hovley #130
City Zip T
Palm Dwmrt 192260
Contractor
Sam
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
340:-9174
State Lic. I City
& Classif. 505699 Lic. # 1383
Arch., Engr.,
Designer
Address' Tel.
No. 46669
BUILDI.NG:.TYPE CONST. OCC: GRP.
A P: Number La QUIUt t lighlands TT 23269
Legal Description
Project Description SF ~ Man D Lot .158
Sq. Ft. 1813 No. No. Dw.
Size Stories- Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
city Zip State
Lic. #
LICENSEDICONTRACTORS DECLARATION
I hereby affirm that;I •am license. under provisjdns of Chapter 9 (commencing with Section
70pp) of Division 3'of the Business and Profe`" ionstt'Code, and my license is in full force and
t.._., �./ ^; �.•-
SIGNATURE' 'DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Liusiness and Professions Code: Any city or county which requires a
permit to construct, atter, bnprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permitto Me 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 cm7 penafty of not more than rive 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 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 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.)
Po`cy No. Company
f 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, 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: N, 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 properly 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
stimated Valuation $Ii293
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 533,34
Const.
643.00
Mech.
60.00
Electrical
149.84
Plumbing
132.30
S.M.I.
7.07
Grading
Driveway Enc.
Infrastructure
2,256.59
TOTAL $3.744.34
"a
REMARKS. trs xaes ,t_r, . r xx.. ,t A -.+vim sxc..
A. tcw a. Y:ihl:3#"1'•r 1::a $ I Ar —. - 7 — a f 4:4 .. ,7-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
.11/17/89
Issued by- Date Permit
Validated by:
Validation:_
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE (If
O
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
METER LOOP
I
OTHER APPJEQUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. SQ. FT. ®
TEMP. POLE
GROUT
DRINKING FOUNTAIN.
WALL SQ. FT.
SERVICE
FINAL INSP.
BOND BEAM
URINAL
SQ. FT. @
GRADING
cu. yd.
$ plus x$
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
01
46
y
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IKITCHEN 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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Yic
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 (If
O
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
71
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
D 0
GAS (ROUGH) (�
�v`
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) G
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. ��/��
FRAMING 3 / l%�
FINAL INSP.
ROOFING Z
01
46
y
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND 3 �"� !
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INRIALS
GARDEN WALL FINAL