07140 (MFD5)T4'ht 4 4 Q"
Building
Address 78-239 Scarlet Court
Soule -yard Bevel
Mailing
Address 777 S. Main St. Suite 1€6
City lZip ITel.
Contractor
Same
City
P.O. BOX 1504 .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
CR 1 92586 1 - 714-547-8056
State Lic. City
& Classif.461814 Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I 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,f' ' " DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason. (Sec., 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, 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 Bus -mess 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).
❑ 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 sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not appy to an owner of property who
builds or irproves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. It, however, the building
or I provement is sold withki one year of completion, the owner -budder will have the burden
of provft that he did not build or improve for the purpose of sale.)
❑ 1, 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
Date Owner
WORKERS' COMPENSATION DECLARATION. °*
1 hereby affirm that I have a certificate of:consento 'self -insure, or a certificate of
Worker's Compensation Insurance; or a certified,copythereof.,'(Sec. 38b0, Labor Code.)
Policy No Compan ✓•�+p. '.l rri�'2 d4�•
❑ Copy is filed with the city. ❑ Certified`copy is hereby fumished.
� ,01
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.)
1 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 of Exemption you should become
subject to the workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this pannif shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
Lenders Address
This is abuilding permit when properly 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. 07140
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 613`790'012
BLD 433 Unit i#294
Legal Description
Project Description plal4 1
Sq. Ft. 926 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Garage included
Estimated Valuation $66,731
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
JIVIII
Const.
491 . ou
Mech.
b4.UU
Electrical
157, EF
Plumbing
1121W
S.M.I.
4.69
Grading
Driveway Enc.
Infrastructure
>,
u
TOTAL
REMARKS
:I
Y�yV✓.. •'.�'t8'i,,iL: �'-"t1:Y}ii1." .1`_'
=C:.J.I i.'s v}..
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 IN�S7_E.CTO�R
Issued by: Date CCS Permit
'Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT ®
DUCT WORK
ROCK STORAGE
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT.
GAS (FINAL)
WALL SO. FT.
DRINKING FOUNTAIN
FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ -Plus-x$-=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
r /
/
1/oI
LAUNDRYTRAY
AIR HANDLING UNIT CFM
VENTILATION
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 I
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/.c
HOUSE SEWER
CERT. OCC.
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
fY!
42
SETBACK
-- --
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. OF
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TA K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. /
(
Z®
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.I), �O
FRAMING �j
FINAL INSP.
ROOFING
r /
/
1/oI
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATr ING
MESH
INSULATION/SOUND J
FINISH GRADING
FINAL INSPECTION] �0va
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL