06676 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 78.845 Villeta Drive ,LA QUINTA, CALIFORNIA 92253
Owner
Tri" Pati a Deaert Dev.
Mailing
Address &a yl -Ay,
City Zip Tel.
Contractor
State Lic.I City
& Classif. __ __.._ Lic. #
Arch.; Engr.,
Designer
Address Tel.
City I Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
' I hereby affirmthat-Cam licensed under Drovi'sions of Chapter 9 (commencing with Section
7000) of Division -3 of the Business and P-iofessions Code, and my license is in full force and
effect. ;J_ _ x't
SIGNATURE '" DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busutess and Professions Code: Any city or county which requires a
permit to construct, after, hWrove, demolish, or repair any structure, prior to Its issuance also
requires the app8cant 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 cW penafly 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 Contractors 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 buaki 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 contractors) 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.)
PolicysNo _Company
41 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 (S 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: fl, 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 abuilding permit when properly filled out, signed and validated, and is subject'to
expiration it 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 Add
City,. State, Zip
No. 06576
BUILDING TYPE•CONST. ' -OCC: GRP.-
A.P. Number- La tTmi:n.ts .Ri&landa IT 23269
Legal Description
Project Description pian ti,4 dot 151
1
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
11117/89
Issued by:', Date Permit-
Validated
ermit
Validated by:
Validation:
Sq. Ft.1�Z3 '
Size
No.
.. Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$10(1,293
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk._Bal.
- 1535.34
.Const.
534.30
Mech.
€0.00
Electrical �,� " k,
1.09.84
Plumbing .
132..50
S.M.I.
7.07
Grading
Driveway Enc.
Infrastructure
A,256.59
r
TOTAL
$3,744 o34
- -, *
REMARKS
1
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
11117/89
Issued by:', Date Permit-
Validated
ermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE ( L
/ Q
ROUGH PLUM.j BONDING
BarFORMS
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
SEWER OR SEPTIC TANK ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
-X7 GAS (ROUGH) ;/' j?( METER LOOP
HEATING (FINAL)
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
AS (FINAL) /� p j�� TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. Ff.
WATER HEATER SERVICE
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE: Not to be used as property tax valuation
INSP.
FLOOR DRAIN
MECHANICAL FEES
J, G1b
C�
(� /a -7, AL tEl-—( 4.C7](Lo-b-F.
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
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.
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 ( L
/ Q
ROUGH PLUM.j BONDING
BarFORMS
HEATING (ROUGH)
STORAGE TANK
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
/
FOUND. REINF. L
/
-X7 GAS (ROUGH) ;/' j?( METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
AS (FINAL) /� p j�� TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
DING
cu. yd.
$ —plus—x$—=$
LUMBER GR.
FINAL INSP. a `i / Q
FRAMING '7/ /'_ No41FINAL
INSP.
ROOFING
J, G1b
C�
(� /a -7, AL tEl-—( 4.C7](Lo-b-F.
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING Yf %
MESH
INSULATIONISOUND
(/
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL