06172 (SFD)Buildin
Address 78-8830 Aurora, Nay
St arl iitht; Dunes
Tihf °f 4 Q"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address p. 0. Box 329
City Zip Tel..
La Quinta 92253 564-2228
Contractor
Address
Tel.
State Lic.I City
& Classif. 387369 Lic. # 202
Arch., Engr., I
Designer
Address I Tel.
City( Zip ( State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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
SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usbess and Professions Lode: Any city or county which requires a
pemhft to construct, after, improve, demoM. or repair any structure, prior to its issuance also
requires the appicaht for such permit to tae a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Secten 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and Ne basis
for the alleged exemption. Any violation of Section 7031.5 by 'any appicant for a permit
subjects the applicant to a cliff penalty of not more than live hundred dollars (1500).
❑ 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, Bhasness 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 himseff or through his own employees,
provided that such improvements are not intended or offered for sale_ ff, 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 build or improve for the purpose or 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 Contractors 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 Contractors 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This sewn need not be completed ff the perm is for one hundred dollars ($100) vafuatron
or less.)
I certify that in the performance of lhp work for which this permit is issued, I shall not
employ any penton in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: ff, after malting 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
1 hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Ciw1 Code.)
Lenders Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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
No. 06172
LDING: TYPE CONST. OCC. GRP.-
. Number Tract 23773
Legal Description
Project Description Lot 10, Model A& Apollo
REMARKS
3�"�«"tt`t:.•t' A" 1T�LHt" f,- ` -'�`7ri•7 t
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
8114189
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft. 2687
Size
No. 2 No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$341,019
PERMIT `
AMOUNT
Plan Chk. "bep.
Plan Chk. Bal.
$ 652.29
Const.
785.50
Mech.
66.50
Electrical
142.35
Plumbing
150.50
S.M.I.
9.94
Grading
Driveway Enc.
`—
Infrastructure
3,222.93
TOTAL
84.9180.91 V/, , %l
REMARKS
3�"�«"tt`t:.•t' A" 1T�LHt" f,- ` -'�`7ri•7 t
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
8114189
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. $
UNITS F
OUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
DUCT WORK
ROCK STORAGE
,.p
FOUND. REINF. /
(
MOBILEHOME SVC.
BAR SINK
POR. SQ, FT. ®
REINF. STEEL
OF
GAS (FINAL) TEMP. POLE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SQ. FT.
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
WALL SQ. FT. ®
LUMBER GR.
DRINKING FOUNTAIN
FRAMING 2/2?
FINAL INSP. d
URINAL
SQ FT ®
REMARKS:
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SQ. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. 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 PLUMBI& 4 ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE q l� e`%�
OUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
/J
SEWER OR SEPTIC 1 7i OUGH WIRING
DUCT WORK
ROCK STORAGE
,.p
FOUND. REINF. /
(
AS (ROUGH) 2 �Z ETER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
OF
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. LO,(.0>
FRAMING 2/2?
FINAL INSP. d
ROOFING �r Z
17
L9
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING a I.,/ If I ti z qc �
MESH
INSULATIONISOUND i1q*w
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
t