06674 (SFD)P.O. BOX 1504 N o .
Building 7&105 CALLE ESTADO
Address 78-825 Vineta Drive LA QUINTA, CALIFORNIA 92253
Owner
TrJAd Pa ific Desert Dev.
Mailing "
Address 7/44-930 IAV 0130
City se
Palm Dert 1. Zip Tel. 92260 903 ,�i74 . w
Contractor
Saute
Address
City Zip Tel.:
State Lic. 5€5699 City 138.3
& Classif. Lic. #
Arch., Engr.,' '
Designer
Address Tel.
City Zip State
Lic. #
f- 1•^ LICENSED CONTRACTOR'S DECLARATION
aff
I hereby irm that' I am licensed under/Drovisions of Chapter 9 (commencing with Section
700tH of Dhnsiond of the Business and'Professions Code, and my license is in full force and
y-. f
SIGNATURE -"" F } DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usiness 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 civilpenalty of not more than five hundred dollars (8500).
,.
0.1, 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,lo 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 -budder 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 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
,h_jCopy 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 tho 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
subject to the workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provsions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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
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 certity 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
BUILDING: -TYPE CONST. OCC: GRP:
06674
A.P. Number .a Ara#1rs�a �S4gblsav Ag TT 2326,1
sw, y t Number C ,� v
Legal Description
Project Description Pmt A R Lot 153
Sq. Ft. $0 *� No. * - No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
(Estimated valuation
$67.445
s
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
421.15
Const.
95.53
Mech.
60.00
Electrical.;" ►' 1`•'
- 86.94
Plumbing
120.50
S.M.I.
4.76
Grading
Driveway Enc.
Validation:
Infrastructure
I,SY7.SY
TOTAL
*2 s 0 •.3 r' ✓`f -er'- `'s�rr
REMARKS
Hies. <ri!t�,1;>,#3..:8ifeW{3fo-i::.r titi
:LvJ_ .a ,P7.).Yf-a"- y.
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 DATEINSPECTOR�
Issued by:
Date 11/17/89Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SO. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF. ��
MOBILEHOME SVC.
BAR SINK
POR. SO. FT.
OTHER APPJEOUIP.
REINF. STEEL
�TE
GAS (FINAL)// Ct 90N`�!i P.POLE
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
DRAINAGE PIPING
CAR P. SO. FT. ®
LUMBER GR.
a
FINAL INSP. ���
FRAMING 3 b,2I 10
DRINKING FOUNTAIN.
WALL SO. FT.
�REMARKS:
n /
J�
URINAL
SO FT ®
VENTILATION
ESTIMATED CONSTRUCTION VALUATION $
FIRE ZONE ROOFING:
WATER PIPING
NOTE: Not to be used as property tax valuation
FIREPLACE
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
SO. FT. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
GARDEN WALL FINAL
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 L /S
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. ��
�AS (ROUGH)
�a �[ V TER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
�TE
GAS (FINAL)// Ct 90N`�!i P.POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
a
FINAL INSP. ���
FRAMING 3 b,2I 10
FINAL INSP.
ROOFING 2-1,
�REMARKS:
n /
J�
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
I