06672 (SFD)P.O. BOX 1504 No.
Building 78--845 hal is Drive. 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
- fried Pacific art Bev.
Mailing
Address 74-925 Wiley $1
City Zip Tel.
Palm Desert .92260. 340-9174.. .
Contractor
Address . _
05,672
BUILDING: -TYPE CONST. OCC:,GRP.
A.P. Number La 0ufnte '8101ands IT 23269
Legal Description .�
Project Description Plan R --R Lot 1S5
City Zip Tela
State Lic. City
& Classif- ' 505699 Lic. # 1383 N _ Sq. Ft. 14Q0 No. No. Dw.
Arch.; Engr-,
Size "Stories ' Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Address' Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm 4hat I am licensed underi6rovisions of Chapter 9 (commencing with Section
7000) of,Division 3 of the :Business`anddP!9fessions Code, and my license is in full force�and
effect �#��"�\ . '" .. 6kL•� .r J t ^N 1 :r
SIGNATURE r it DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's 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 appficant for such permit to We 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 five hundred dollars (E500).
❑ 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 or completion, the owner -budder will have the burden
or proving that he did not build or improve for, the purpose of safe.)
❑ 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 or property who builds or irtproves.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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. .Company
bCopy 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 pemnit is for one hundred dollars ($100) valuation
or fess.)
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: If, after making this Certilicate of Exemption you should become
subject to the Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this pemnit 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, Cin? Code.)
Lender's 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 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
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
AMOUNT
458.50
` 545.00
60.00 '
Grading
Driveway Enc.
Infrastructure
lo,769.11
TOTAL
$3,053.12
REMARKS
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
IST FL. SQ. FT. a $
UNITS
COLL, AREA
SLAB GRADE Z y
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF./
!/
POWER OUTLET
ROOF DRAINS
GAR. SQ. Fr. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REINF.'STEEL
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
DRINKING FOUNTAIN.
WALL SQ. FT.
FINAL INSP.
BOND BEAM
URINAL
SQ. FT. @
GRADING
cu. yd.
$ plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.� �`9
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING •vr �
FLOOR DRAIN
MECHANICAL FEES
/��
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING:
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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 , , ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE Z y
UGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTICTANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF./
!/
f AS (ROUGH) v7 �Q( q
ETER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF.'STEEL
GAS (FINAL) Gr (( C
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.� �`9
FRAMING 3 Q
L
FINAL INSP.
ROOFING •vr �
J(G
�,� � Q%J/J
/��
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING O ,W
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINTTIALS
GARDEN WALL FINAL