05078 (SFD)T 0 0
1 4,!t 4 4 Q"
Building
Address 54-563 Inverness
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address to Inn
City Zip Tel. `
Pairs Desert 1 9226 568-2828
1 NO
Address
ity IZip I Tel.
+w.
State Lic. City
&Classif. 288130 Lic.# 328
Arch., Engr.,
Designer
Address Tel.
CityIZip I State
_ Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of -Division 3 of the Business and Professions Code, and my license is in full force and
At
e , I^-
SIGNATURE - - - DATE
( OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 703f: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 applicant for such permit to We a signed statement that he is licensed pursuant to
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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 10a civil penalty of not more than fnve 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 appy to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such irwrovermints are not intended or offered for sale. n however, the building
orimprovement 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.)
❑ 1, 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.)
O 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section 'need not be completed ff the permit is for one hundred dollars (S100) valuation
or less.)
I certify that in the performance of thg wwork 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_!_' F- I Owner 1 �.
NOTICE TO APPLICANT: ft, after making this' -Certificate of Exemption you should become
subject to the Workers' Compensation provisions or 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
LDING: TYPE CONST
No.
OCC: GRP.
05078
A.P. Number Af`6 X Qgt _ 011agn 9AA
Legal Description
Project Description Plan- 1Mk
Sq. Ft. 1330 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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
12/27/88
Issued by: Date Permit
Validated by:
Validation:
Estimated Valuation
$94,224
- PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
a ? A, Q
Const.
rA
Mech.
34,00
Electrical
A
Plumbing
S.M.I.
A9
Grading
Driveway Enc.
Infrastructure
g I �1`0 44
9
Leas Credit
1,060.25
TOTAL
1$2,008.85.
-
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
12/27/88
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FF,ES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
y, UNITS
SLAB GRADE
ROUG PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
ER OR PTI T K
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS'
AS (FINAL)
TEMP. POLE
DRAINAGE PIPING '
CAR P. I SO. FT. ®
GROUT
I
WALL SQ. FT. ®
-'
DRINKING FOUNTAIN.
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
ING
FLOOR DRAIN
MECHANICAL FEES
Q6��
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SULATIONISOUND
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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
ROUG PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR PTI T K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
AS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
VICE /
t
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
ING
FINAL INSP.
ROOFING
Q6��
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
L
MESH
SULATIONISOUND
FINISH GRADING
F INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL