07197 (MFD5)Un
Addrdess 78-231 Scarlet Cort
$ouievard revel
Titif 4 4 a"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 777 S. Esaan Street SOte 106
City Zip Tel.
QranQe CA 92686 714-547-8056
Contractor
Sam
ity
State Lic. City
& Classjf. 461814 Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip IState
Lic. #
LICENSED CONTRACTOR'S DECLARATION'
I hereby affirm that 1, 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. �. r r
SIGNATURE'-" esu i i; _ {' .a`ri%a+` is.� DATE
// OWNER BUILDER DECLARATION
I hereby`afiirin thaf I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busiress and Professions Code: Any city or county which requires a
permit to construct, after, kri rove, demolish. or repair any structure, prior to its issuance also
requires the applicant for such perml to tae 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 viofattion of Section 7031.5 by any applicant for a permit
subjects the applicant to a clivi penally of not more than five hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractors License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for safe. If, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or iri rove for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who bunds or improves thereon, and who contracts for
such projects with a contrador(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec- H. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION f
I hereby affirm that I have a certificate of,consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a_certified copy -thereof. (Sec. 3800, Labor Code.)
Policy No Company,
❑ Copy is filed with the city. ❑ ed copy'is hereby'fumished.
r
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the Penult is for one hundred dollars ($ 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 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
subject to the Workers' Compensation provisions of 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, Cfvft Code.)
Lender's Name
Lenders 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.
I certity 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
No. 07197
11LDING: TYPE CONST. � OCC: GRP
P. Number 613-790-012
Description
Project Description
BLD #31 Unit #298
Pi an 31.
Sq. Ft. 763 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
IEstimated Valuation $56 ,886
PERMIT
Plan Chk. Dep. ,
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL s
AMOUNT
44b.UO
49.'O
52.67
94. Sfl
3.99
1,Z79.94
REMARKS Ire ; f `t194 iR£at4TM6-4i1 o . �;ft 10
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: Date 2/21/901 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL AREA
SLAB GRADE fC'(3 Q�
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SQ. FT. ®
DRINKING FOUNTAIN,
GROUT
WATER HEATER
URINAL
SQ FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ —Plus—X$—=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVARCOOL HOOD
SIGN
WASHER(AUTOXDISH)
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, TEMIPERM
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.
SO. FT. RESID ® 11/4 C
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
INSULATIONISOUN�j�-J Qh
n C/
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 , e , ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
, UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE fC'(3 Q�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. S Z Q�Q
GAS (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.
FINAL INSP.
FRAMING 90
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. IREWALL
LATHING �
MESH
INSULATIONISOUN�j�-J Qh
n C/
FINISH GRADING
FINAL INSPECTION Y3Sp L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t