SFD (06040)53770 Avenida Martinez
06040
4 a P.O. BOX 1504
Address' 53-770 Hart Z LA.QUINTACCAL CALIFORNIA 92253
Address
Owner
Meadow lAwd 'er.
Mailing
Address Box 921
City Zip Tel.
Rialto 714--575-6000
Contractor s
ow er i9Ltilder
State Lic. City
& Classif. 361079 Lic. # 1175
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
71100) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professwns Gide: Any city or county which requires a
permit to construct, after, Improve, demofush, or repair any structure, pdor to its issuance also
requires the appficant for such permit to lite a signed statement that he is licensed pursuant to
,h provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Mviston 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
subjects the appficant to a civil penalty of not more than five hundred do8ars ($500).
❑ 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 Contractor's 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 sale. lf, however, the building
orimprovement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or improve 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 builds or irtproves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
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. ❑ 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 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
alifornia.Dateowner
NOTICE TO APPLICANT: If, atter making this Certificate of Exemption you should become
subject to the Workers' Compensation provnsions 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, 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.
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
ateMailing Address
City, State, Zip
No.
11LDING: TYPE CONST. OCC: GRP...
P. Number 774"172-002
Description
Project Description
Lot 23
S.F.D.
Sq. Ft. No. No. Dw.
Size 12£4 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
;sewer, no septic
stimated valuation
74,075.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
204.91
Const.
527.00
Mech.
53.50
Electrical
101.46
Plumbing
157.5£
S.M.I.
5.25
Grading
20.00
Driveway Enc.
C ,=.00
Infrastructure
1628.45
Precise Plan
25.00
TOTAL
i
REMARKS
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
it -28-89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
l4AB GRADE,/,d-/,T CGj
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
STORAGE TANK
FORMS
`
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN.
WALL SQ. FT.
BOND BEAM
WATER SYSTEM
URINAL
SQ FT g
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
'q
//f/
r
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. 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
SWFFEF_j PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
>/�
GROUND PLUMBIfy[
rl//SETBACK
UNDERGROUND
A.C. UNIT
COLL. AREA
l4AB GRADE,/,d-/,T CGj
ROUGH PLUMB.
BONDING —
HEATING (ROUGH)
STORAGE TANK
FORMS
`
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER 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.
FRAMING 90
FINAL INSP
ROOFING r �) /
VENTILATION
Ok //CJI
,` , -V
'q
//f/
r
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REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION �� At
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
NOTICE: THIS DOCUMENpAALftGn FEES
BE DUPLICATEDL . .
TO: City of La Quinta DATE: �q
Department of Community Development
78-105 Calle Estado1
La Quinta, CA 92253 All,�
%at
Eto certify hat (,C) rdevelwhich is
locat_ O c within
this District, has paid school facili y fees imposed pursuantto the
aut ity generat� by Gov rnment Co a Sectiolt 5308 in t @ mount of,
$ 4
covering a total of square feet of (&) residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
C� 143 6 61 17.64 c�
u -/- H3567- PtH E -9WPV&� 0, eftz22ft)
C]/ --:w 14 /b 563 for DESERT S qDS UNIF ED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
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