06520 (SFD)414 Qum& �
P.O. BOX 1504 No. 065203�
Building 54-37.0 Riviera 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 42-600 Coat St., #200 A.P..Number PGA West —'bract 24317—I
City Zip Tel.
Pasta Desert 92269 568-'2828 Legal Description
Contractor
Project Description 1Ats
1r7 f! i Ax1� M,t't OFr
Address
City Zip TeL
State Lic. City
& Classif. 288130 Lic. # 328 Sq..Ft. 3401 , No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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. w'
�GNATURE DATE
OWNEWBUILDER DECLARATION Estimated Valuation
I hereby affirm that 1 am exempt from the Contractors License Law for the following $243,430
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
permit to construct, after, inprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Fite a signed statement that he is licensed pursuant to PERMIT AMOUNT
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 Plan Chk. Dep.
subjects the applicant to a cn d penalty of not more than five hundred dollars ($500)926.58 a s
O 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 6, 8
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COfISt1 . i�.
Professions. Code. The Contractor's License Law does not apply to an owner of property who . !
00
builds or reproves thereon and who does such work himself or through his own employees, 81.50
Provided that such Ewrovements are not intended or offered for sale. If, however, the building Mech.'
or improvement is sold within one year of cortpletion, the owner -budder will have .he burden Electrical 183.92
of proving that he did not build or inprove for the purpose of safe.) '•'
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
$d.,�
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law _ -30
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I, 17.01
such projects with a cordrador(s) licensed pursuant to the Contractor's License Law.)
Grading
O I am exempt under Sec- w- & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure $S,'•e'5k..68 2,727.34
tress Credit 2.727.34 8
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
O Copy is filed with the city. O Certified copy is hereby fumished.
TOTAL $5,256.85
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS COMPENSATION INSURANCE
(this section need not be completed ff the permit is for one handled dollars (E 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: ff, after making this Certificate of Exemption you should become ZONE: BY.
subject to the IAbdrers' Compensation provisions of the Labor Code, you must forthwith
awmpy with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, ChdCode.) Side Setback from Property Line
Lenders Name
Lenders Aderess FINAL DATE INSPECTOR
'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. 10/13189
1 certity that I have read this application and state that the above information is correct. Issued by: Date Permit
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 Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL: SO. FT.
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. Fr. ®
EWER OR SEPC�,j
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
REINF.
DRAINAGE PIPING
CARR SO. FT.
HEATING (FINAL)
OTHER APPJEOUIP.
WALL SO. FT.
DRINKING FOUNTAIN.
SO. Fr. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.-1
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OOFING —!(
LAUNDRYTRAY
AIR HANDLING UNIT CFM
/) /,��� QU
O` � �-N�---
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.
SO. FT. ® c
BATH TUB
SO. Fr. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.0
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
THING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTA_ FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SIVBACK
UND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPC�,j
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
REINF.
(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
EINF. STE %
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.-1
ERAMING `(� O
FINAL INSP.
OOFING —!(
Q
Ole, 7d ��2�
/) /,��� QU
O` � �-N�---
4t
REMARKS:
VENTILATION�('rv'
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
SULATIO /
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL