05064 (SFD)I�
Building
Address
Owner
Mailing
Address
City
1 tf' Ij 1t
P.O. BOX 1504
78-105 CALLE ESTADO
5.4"405 Inverness � LA.QUINTA,.CALIFORNIA 92253
Sunrise- C
Contractor
Address
6-
Ltn 9_f30
Tel.
56f;•.L.�.G2S
{
No. 05064
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number pFalk E1Antr .. WNA"o% AnA
Legal Description
a
Project Description Cl P" 4 cy
City Zip Tela ^
State Lic. City
& Classif. 288130 Lic. # 328 Sq. Ft. 1918 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 that I am licensed under Provisions of Chapter 9 (commencing with Section
=of Division 3 of the Business and Professions Code, and my license is in full force and
1
SIGNATURE DATE
OWNER -BUILDER DECLARATION
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
plural to construct. alter, irprove, demofsh, or repair any structure, prior to its issuance also
requires the applicant for such permit to tae a signed statement that he is licensed pursuant to
the provisions- of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Dvfsfon 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation or Section 7031.5 by any applicant for a permit
subjects the applicant to a ova penalty of 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 Contractors License Law does not apply to an owner of property,who
6u7ds or improves thereon and who does such work himself or. through his own employees,
provided that suchrrpovements are not intended or offered for sale. If, however, the building
or it provenerd is sold wNd one year of completion, the owner -builder will have the burden
of proving that he did not buil or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec- 7044, Bushess and Professions Code: The Contractor's License Law
does not apply to an owner of property who bunds or improves thereon, and who contracts for
such projects wlth 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
w lI affirm that I have a certificate of consent to self -insure, or a certificate of
pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Polity No Company
❑ Copy is filed with the city-. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(chs section need not be completed ff 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 penton in any manner so as to become subject to the Workers' Compensation
Laws of Califomia
Date, I Owner
NOTICE TO APPLICANT: 9, after analarig this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply wah 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
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 days.
1 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 Adder
City, State, Zip
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
Estimated Valuation
$132,816
PERMIT
Issued by-
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 442.73
Const.
515.50
Mech.
34.00
Electrical
74.59
Plumbing
87.50
S.M.I.
9.28
Grading
Driveway Enc.
Infrastructure
$2,988.36
1,494,18
Less Credit
1.4'94.18
TOTAL
$2,657.88
REMARKS
' �)i�}� � 41E-�i %rr'Y s�•Xfi Sir, b � _..'T ��..,.�• r' -a tZ:-� 4t
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
12/77/88
Issued by-
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FI.. SQ. FT. ® $
UNITS
GRADE
ROM PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
SEWER OR SEPTIC T
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
(ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
AS (FINAL
TEV.
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SD. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM 7Y9
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
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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
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.
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 ® 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
SBACK
UND PLUMBING "�3
UNDERGROUND
A.C. UNITIF
LOLL. AREA
GRADE
ROM PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
SEWER OR SEPTIC T
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REINF.
(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
AS (FINAL
TEV.
GROUT
WATER HEATER
. IC
FINAL INSP.
BOND BEAM
WATER SYSTEM 7Y9
GRADING
Cu. yd.
$ plus x$
_$
LU ER GR.
FINAL INSP.
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FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GYA. FIREWALL
LATHING
MES
IONISOUND �s
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL
t