06543 (SFD)T4hf
P.O. BOX 1504 No. fl 653�5
Building 54-4013 Riviera78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
r1.8t'� c4t13'tl�liy
Mailing BUILDING: TYPE CONST. OCC: GRP. -
Address 42-600 $€3025 St... #200 A.P. Number PCA_ West — Tarot 24317-1
City I Zip JTel.
Pals Desert
Contractor
city Zip Tela
State Lic. City
& Classif. 288130 1 Lic. # 328.1
Designer
Address
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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License law for the following
reason: (Sec. 7031.5,0usness and Professions Code: Any city or county which requires a
permit to construct, after, krpmve, demolish, or repair any structure, prior to Its issuance also
requires the applicant for such permit to lie 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 vkA3ton of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenally of rpt more than five hundred dollars ($500).
O 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 sate. (Sec. 7044, Suisness and
Professions Code: The Contratlw's license Law does not apply to an owner of property who
!wilds or krproves thereon end 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 krprove 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 reproves thereon, and who contracts for
such projects with a contractorfs) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec_ R, & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Work
efs Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM'
WORKERS' COMPENSATION INSURANCE
(This section need not be oumpkted 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 person m any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT 8, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or On pend shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 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 Address
City, State, Zip
Legal Description
Project Description PhttM�Q Pl= C3SR
Sq.,Ft. 3831
Size
No., No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$272,603
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
S1 010.30
Const.
1.245.00
Mech.
81.50
Electrical
Dia ,45
Plumbing
198.50
S.M.I.
19.11
Grading
Driveway Enc.
Infrastructure
$6*000.00 3,000.00
Less Credit
.00
3.M.00
TOTAL
$5.754.86 1_1 j ` ;1 1 / ' . r1
REMARKS
z f t yrs . rt r' c, - ts..d L _ CCc_ A 1f 11
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
1f3I1b18�
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
(gSSLAB GRADE — S^—
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS le4EWER
OR StVyfKfo
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
1,4AS (ROUGH)/��\
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL S0. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SO FT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
IleAkRAMING 3f
WATER PIPING
NOTE: Not to be used as property tax valuation
T
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L 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.
SO. FT. ® c
BATH TUB
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR ® 3144c
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
WC6ETBACK " �jv
ND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
(gSSLAB GRADE — S^—
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS le4EWER
OR StVyfKfo
ROUGH WIRING
DUCT WORK
ROCK STORAGE
(C FOUND. REINF. -�
(((
1,4AS (ROUGH)/��\
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
NAL INSP.
IleAkRAMING 3f
FINAL INSP.
OFING QQ
� �2o'Ti�-
T
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
G4NNSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL