6878 (SFD)CV
4 Qak&
P.O. BOX 1504 No, 06878
Building 78-105 CALLE ESTADO
Address 1�i) ; LA QUINTA, CALIFORNIA 92253
f?cot:illo Lr_v+•
Owner
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address 2-60: Cook Strees, Suitt: 13.5 A -P. Number Tract 24517 - Rancho Ocotillo
City I Zip JTel.
i?aLi �sert 92260I 345-1-541
Contractor
rUlllanis Dee. Corp.
Address
City lZip
State Lie. City
& Classif. 493919 Lie. # 1:-31
Arch., Engr.,
Designer
Address I Tel.
CityI Zip State
I I Lie. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
effect7000) of Division 3 of the Business and Professions Code, and my license is in full force and
SIGHATGRE _ GATE
OWNER -BUILDER DECLARATION
hereby affirm Shad I am exempt from the Conlra;Mr's License Law for the following
reason: (Soc. 7031.5.ausirs°ss and Prmrossions Code: Any City or county which requires a
permit to .amstruck aff®, irpruvo, doma6.sh, at repair any structure, prior to its issuance also
requires the appfeant for such permt to Tike a signed statement that he Is licensed pursuant to
Tho ptoWsions of the Contracloes License Law, Chapter 9 (commencing with Section 7000) of
apishm 3 of the Business and Professions Code, or that -he is exempt therefrom, and the basis
for the alleged exempacn- Any violation of Section 7031.5 by 'anyapp7icamt for a perhill
subjects the apprcnt to a chff penally of nor more than Irm hundred douars jS 500).
L 1, as owner of the property, or my employees with wages as their sole compensation, wi11
do the work, and the structuro is not intended or offered for sale. (Sec. 7044, Sursness and
Aufesswrs Cade. The Contractors License Law roes nal apply to an owner of property who
bu4ds or improves Memm and who does such work himself or through his .awn employees,
provided that such Kniannfinents are nor mrerrded or offarad for sara- if,, however, the building
Of ropmvemenf is soli wW*t ora year or oorrpfeWn, rhe owner-buMar wid 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 Prufesslons Code: The Contractor's License Law
does not apply to an owner of properly who bunds or improves thereon, and who contracts for
such projects with a contractor(s) icensed pursuant to the Contractor's License Law.)
❑ I 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
(Thi socbpn need not be completed if Ore pemwt is for one hundred dollars ($100) valuation
or Iess.J
1 certify that in the performance of (hg work for which this permit is issued, I shall not
employ any penton in arty manner so as to become subject to the Workers' Compensation
Laws. of California
Date rlwner
NDTICE TO APPOCANT- k, after making this certificate of Exemption you should become
wise/ to the Workers' Cmpensaacn provisions of the Labor Code, you must forthwith
congcfy wrbh such provisions or chis Parmif 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.)
Lenders Name
Lender's Add
This is abuilding permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
certify (hat I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and stale laws relating to building
construction, and hereby authorize representatives -of this city to enter the above.
mentioned property for inspection purposes -
Signature of applirartt Dam
Mailing Address
City, State, Zip
Legal Description
Project Description Plain 1 Model, Tot 3
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
1/17/90
Issued by: Date Permit
Validated
Validat
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep,
$25.00
Plan Chk. Bal.
f' 338.19
Const.
706.00
Mech.
r) . 011
Electrical
1.'.3.11
Plumbing
150.50
S.M.I.
8.33
Grading
Driveway Enc.
Infrastructure
2, 669.47
TOTAL
$4,305.60
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
1/17/90
Issued by: Date Permit
Validated
Validat
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES NO.
PLUMBING FEES
$
UNITS
DUCT WORK ROCK STORAGE
1ST FL SQ. FT. ®
GAS (ROUGH) �(� i:r METER LOOP
HEATING (FINAL) OTHER APPJEQUIP.
REINF_ STEEL
GAS (FINAL) TEMP. POLE
YARD SPKLR SYSTEM
2ND FL SQ. FT.
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT.
DRAINAGE PIPING
CAR P. SO. FT.
DRINKING FOUNTAIN
WALL SQ. FT.
URINAL
SQ. FT.
WATER PIPING
ESTIMATED CONSTRUCTION VALUATION $
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENTSYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
GARBAGE DISPOSAL
APPLIANCE DRYER
FURNACE UNIT WALL FLOOR SUSPENDED
I LAUNDRY TRAY
KITCHEN SINK
AIR HANDLING UNIT CFM
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
POLE, TEM/PERM
LAVATORY
COMPRESSOR HP
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
SQ. FT. ® c
BATH TUB
BOILER B.T.U.
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B_T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
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 1471ROUND PLUMBING3/.V/5j;:� UNDERGROUND ' A.C. UNIT ` COLL. AREA
SLAB GRADE 7(y 1 ! " r
ROUGH PLUMB. BONDING
HEATING (ROUGH) STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK ROCK STORAGE
FOUND_ REINF._6� /x
GAS (ROUGH) �(� i:r METER LOOP
HEATING (FINAL) OTHER APPJEQUIP.
REINF_ STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP.-CU. yd.
y�
FRAMING ✓ ( 'e G FINAL INSP. 1$ plus -x$-=$
REMARKS:
ROOFING
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