001564 (SFD)Building 53--3 0
Address
.,..,, RJiT.0hr-SM CMWt.
Mailing
Address P.O. H= 228
City lZip ITel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
.. I 9=1 347-7171
Contractor
Address .
=
City lZio Tel.
State Lic.Cit
& Classif. T� �i '. Lic. 202
Arch., Engr.,
Designer
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
/7000) of Division 3 of the Business and Professions Code; and my license is in full force and'
:effect. til
,SIGNATURE DATE
OWNEIi-BUILDER DECLARATION
1 -hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason:(Sec. 7031.5,Business and Professions Code: Any city or county which requires a .
"permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance' also
requires the applicant for such permit to file 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 civil penalty'of not more than five hundred dollars "($500).
O 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 Lawdoes 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 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 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.) -
❑ 1 am exempt under Sec. B. & P.C. for this reason
1
Date Owner
4
WORKERS' COMPENSATION DECLARATION
1 ' 1 hereby affirm that I have a' certificate of consent to self -insure, or a certificate of -
F Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
`( Policy No: Company
111 O Copy is filed with the city. O Certified copy is hereby. turn ished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) '
I certify that in the performance of the 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: If, after making this Certificate or 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.
IQ. r
Signature of applicant ''at -'4 i� -e 1 il�C�'r'"h Daterl'
Mailing Address r
City, State, Zip
HARD COPY
No. 001564
BUILDING: TYPECONST. Wq OCC: GRP. R 3
A.P. Number 7744"045-005 lot 5
Legal Description
Project. Description_3a_1�_
Sq. Ft. DhTG 1592
Size 40
Newt. Add ❑
No. No. Dw
.Stories Units
Alter ❑ Repair ❑ Demolition ❑
REMARKS
ZONE:
BY:
Estimated Valuationlp g444�37.�"
PERMIT '.
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
+
const.�e
Mech.
,
Electrical
70.12
Plumbing '
$9.00
S.M.1. f
5.71
Grading
Driveway Eno.
Z,
Infrastructure
TOTAL
qtr
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback trom.Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
'Issued by:
Date Permit
Validated by:
Validation:
A16Z8
6 18 213506 R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIMt, FF.Ef°; ,
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
r SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING
GAS PIPING
PERMIT FEE
REMARKS:
PERMIT FEE
PERMIT FEE
DBLAL
TOTFEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBING ��
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
'ROUGH
�LEWER OR SEP
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
�VI
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING S 2,0 d ' f,
MESH
INSULATIONISOUND 0 j ai
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL .
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL
_ O
Desert Sands Uip I Sc� ool' District
N:BERMUDA DUNES
RANCHO MIRAGE
82-879 HIGHWAY: 111 6;;IND0--.!CALIFORNIA 92201 -56;78 0 16191 347-8631
" INDIAN WELLS �+
PALM'OESERT a
A'p r i la.23 '� 985
J` LA ,OUINSA
'gip -INDIO 1?
-^t
City of La Qu '.nta
Department of'..Community Development' ..
78-105 Calle Estado
La: Quinta, CA 92253
Re: 5.3-080 Averi i;da
Obregon "
Gentlemen:'
The developer of the
;above. referenced.lot
has mitigated i•ts�.Jmpacts :on' our,..overcrowded schools bye' payment
of the amount of. $628 per una.t to be _app]. 1 e'd to the cost of
district educational
facilities made necess'ar.-.y by such. new
development.
Sin '
John D.:. Brooks
"
•A'ssi stant Superi nte.ndent
'Bus.iness Services
JDB/crm
.a t,