9606 (RPL)I T-ity 4 aCPQamrw
P.O. BOX 1504
Building n,. t ; ,;_r 3.�., , ,; 78-105CALLE ESTADO
Address ` ' t''"�' y "--LA`OUINTA, CALIFORNIA92253
Owner
Mailing
Address
City Zip Tel.
Contractor
Address
Zip I Tel.
State Lic. j City
& Classif. I Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip I State
I 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
effect.
ONATURE i1A LE
OWNER -BUILDER DECLARATION
I her affirm that I am exempt from the Contractor's License Law For the following
reason- [Sec. 7031.5;Business and Profess(= fade: Any city or county which requires a
permit do consuucf, after, improve, demolish, or repair any structure, prior fo ifs issuance at5D
requires the applicant for such permif to life a signed slalement thal he is licensed pursuanf to
fha provisions of rho Conbaclors License Law, Chapter 9 (commencinS with Section 7000) of
fdlvfsicn 3 of the Business and Professldns Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of &action 7031.5 by 'any applicant for a permit
rNOS !hs appNcanl to a civypenally of not more than We hundred dollars (S500J.
I, as owner of the property, or my employets with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. fsec. 7044. Bussness and
Professions Code: The Contractor's License Law does nor apply to an owner of properly who
builds or improves !hereon and who does such work himself or through his own employees.
provided that such kuprovem ms am not intended or offered for sale, if, however, the burning
or frr-0provemenf is said within one year of completion, the owner -builder wig have the burden
of proving that he did not build or improve for the putpose of sage. )
❑ 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 nor apply to an owner of properly who builds or Improves thereon, and who contracts for
such projvcls with a contractor(s) teen:;ed pursuant to the Cdnlmclnr's License Law.)
❑ 1 am exempt under Sec. 6 B. & P.C. for this reason _
Dale Ownv�
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 if the permit is for one hundred dollars (S100) valuation
or less.)
I certify that in the performs ce of thg work,for which this permit is issued. I shall not
employ any person in any manner so as to Laws of CaliforniaIsepbme subject to the warners' Compensation
. v
Date Owner
NOTICE TO APPLICANT: 7 r making 1h7s C+arlifrcale of Exomplicn you should become
subject to the Workers' rnpensalfan provisions �of the Labor Cede, 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
explration if work thereunder is suspended for 180 days.
I certify that I have read this appilcadon and state that the above informatton is correct.
i agree to comply with all city and county ordinances and state laws rotating to building
construction, and hereby authorize representatives of this city t4 enter the above -
mentioned property for inspection purposes -
Signature of applicant Date
Mailing Address
City, State, Zip
No. 9606
BUILDING: TYPE CONST. OCC- GRP.
A.P- Number�C t''I
Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep-
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
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
Issued by: D?te Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. ®
SQ. FT. @
SO. FT. @
SO. FT. ®
SQ. FT. @
SQ. FT. @
SQ. FT. 0
VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
WATER PIPING
NOTE: Not to be used as property tax valuation
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,TEM/PERM
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
SO.FT.GAR ® 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE TNST.
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
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
FOUND. REINF
SEWER OR SEPTIC TANK
GAS (ROUGH)
ROUGH WIRING
DUCT WORK
ROCK STORAGE
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd.
lus x$
=$
LUMBER GR.
FINAL INSP./Z 3 q r
FRAMING
FINAL INSP.
T-��cu.
ROOFING
,L (1 J I7 /� — EI"C�
'[Yi U'
C���- L.�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION +�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIG NATURESIIH171AL5
GARDEN WALL FINAL
APR 2 2 1991
March 26, 1991
Architectural Committee
La Quinta Palms Owners Association
Euclid Management
125 S. Mountain
Upland,'CA'91786
RE: Lot 29
Dear Sirs,
Attached please find the proposed plan for the new portable spa at
79-439 Horizon Palms Circle.
Exhibit 1 indicates the area including 79-443 and 79-439 Horizon Palms Cir.
Exhibit 2 provides detail and elevation for the area
Exhibit 3 provides detail of fencing and sidewalk.
Should you have any questions, please contact me at:
PO Box 2704
Huntington Beach, CA 92647
(714) 842-5100
Very truly yours,
7
1
R. Eugene Burke, Owner
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