MISC (05884)44285 Marigold Lane
05884
r P.O. BOX 1504
Building 3 78-105 CALLE ESTADO
Address 44-2ft Marigold Lane LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address A3-'875 T28 4I 1 ta t •
A.P. Number.
City Zip Tel.
Lie Mata 1. 92253
No.
BUILDING: TYPE CONST. OCC: GRP.
Contractor
Address
H.Ge
Sam
Zip Tela t ,.
State Lic. City
& Classif. 493919 Lic. # 1231
Arch., Engr_,
Designer
Address Tel.
"City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7008) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. 'a
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
,'reason: (Sec-• 7031.5,Bushess and Professions Code: Any city or county which requires a
permit to construct, alter, irpmve, denpish. or repair any structure, prior to its issuance also
requires the eAufficard for such permit to fie a signed statement that he is licensed pursuant to
the provisbrts of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Busyness and Professions Code, or that. he is exempt therefrom, and the basis
for. .the alleged exenption. Any violation of Section 7031.5 by 'any applicant for a permit
"subjects the applicant to a avipenally otnot more than rive hundred dollars ($500).
Kr; O'1: as owner of the property, or my employees with wages as their sole compensation, will
civ• do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
.r Professions Code. The Contractors' License Law does not apply to an owner of property who
builds or irlproves 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 bold or improve lar 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.)
❑ I am exempt under Sec B, & 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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. 0. Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: 9, after making this Certificate of Exemption you should become
subject to the Workers' ConpensaSon provisions of the Labor Code, you must forthwith
commpty with such Provisions or this pend shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that then: is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lenders Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and Hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes
Signature of applicant Date
Mailing Address
City, State, Zip
Legal Description
BS8 nLot 27
Project Description. Pl+.-n 3AR .Cactus F1r. err
Sq. Ft. 1533 No. No. Dw.
Size- Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation$,$25.q
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal
4.80..03
Const.
5$ •tii3
Mech.
J
Electrical
84.42
Plumbing
120. 5
S.M.I.
9-09
Grading
Driveway Enc.
Infrastructure•
b
TOTAL..'''.
t
REMARKS
w`v..». ott.rtin`•.c',t-rstr.:._i - ..._..r.>,u -
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: Date6
M15-89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SQ FT @
f 0 T
T
GAS (ROUGH) if ETER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT.
GROUT
WALL SQ. Fi.
FINAL INSP.
DRINKING FOUNTAIN.
SO Ff ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE Not to be used as property tax valuation
ROOFING G
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL r]
LATHING %J V
MESH
INSULATIONISOUND %6 6
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
rrurc c uw
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL 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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 PLUMB22 ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. 2
f 0 T
T
GAS (ROUGH) if ETER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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.) f
FRAMING Z' FINAL INSP.
ROOFING G
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL r]
LATHING %J V
MESH
INSULATIONISOUND %6 6
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
rrurc c uw
C iil D
REMARKS:
SIGNATURESHNITIALS
GARDEN WALL FINAL