12559 (RR)P.O. BOX 1504
Building 78-105 48-895 EIGHL PALMS LA QUINTAC
Address CALIFORNIA 92253
SAINT P.WCIS OF ASSISI CHURCH
AddreMailinss 4$-895 HIGHU 7I) PAUMS
City Zip Tel.
LA QUI
I A . 8 253
COntraDAV'IS RO€ FIRG '
Address
-51-07.5 CALLS PALOXA
CityZip Tel.
LA t�UINTA 92253 564-0407
'State Lic. City
& Classif. Cs39 Lic. # 530086
•Arcn., tngr.,
=' Designer
Address Tel.
^City. Zip 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 Bus/in�ess1s� and Professions Code, and my license is in full force and
effect
%. y{cl'txCiL.�� {-vis
s.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
•4 w,l1-hereby affirm that I am exempt from the Contractor's License Law for the following
reason: -(Sec. 7031.5,Business and Professions Code: Any city oricounty which requires a
permit to construct, alter, 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 o/ 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 -!he .alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars ($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. 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 build or Improve for the purpose o/ 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.)
'0 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.)
Po°Vy �P• 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 if the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg workjlfor which this permit is issued, I shall not
employ any person in any manner so as t - become subject to the Workers' Compensation
Laws of Calitornia.a
Date�t^Oner S!�-
NOTICE TO APPLICANT: I/, after making this Ce�r i/icate 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
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.)
Lender's Name
Lender's 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. 12559
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description
OCC: GRP.
RE ROOF RECTORY
G'ARAG'E
Sq. Ft.
Size
No.
Stories
No. Dw. -
Units
New ❑ Add ❑
Alter ❑
N
Repair 8-
:.Demolition ❑
Estimated Valuation
t
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
$30,00
Mech.
Electrical
Plumbing
.S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
y
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 Linel
j
FINAL DATE
Issued by:
Validated by:
Validation:
t SPE
U n
SPE
DEC 0 2/ 1993'
JUJ
l��1'i f•ii: ..
R
Permit t
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. 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. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
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
VENTILATION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
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
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING 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:
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. 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
FINAL INSP.
ROOFING /2-2.� 3
JJ
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION Z --B 3
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL