15009 (SIGN)Ti -ht 4 4 Q"
Building r
Address 7.8-250 - ficttiway 111
Owner La Q12inta Clif fhouse
Mailing
Address same as above
City Zip
Ira Qii].nta 1,92253
Contractor
P.O. BOX 1504
78-495 CALLE TAMPICO
LA GUINTA, CALIFORNIA 92253
360-5991
,,,.......2660 Che' rokee Way
City Zip Tel.:
Pam. Springer 92264 3238-6275
State Lic. City
& Classif..524483 Lic. #
Arch.,,Engr.,:
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 'Sectio
n '
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Sustness and Professions Code: Any •clty. or county which requires a
permit to construct, alter, improve, demolkh, 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 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 applicant to a civil penalty of not more than five 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 thatsuch 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 knprove for 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 contractors) pcensed pursuant to the Contractor's License Law.)
' ❑ lam 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, O 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 the work for which this permit is issued, I shall not
employ any pparson in any manner so as to become subject to 4he Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, a8er.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 permit shall be deemed revoked.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION.TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This Is a building permit when properly filled out, signed and validated, and is subject to
expirationif 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. 15009
BUILDING: TYPE CONST. - OCC: GRP."
A.P. Number
Legal Description
Project Description �n las' ted Sian
Sq. Ft.
Size
No: No. Dw.
Stories Units
New O Add ❑_
Alter O Repair ❑ Demolition '
Estimated Valuation8
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
c a
Mech.
Electrical
Plumbing- .
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
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
Issued by: Date FeOQS,
Validated by:
APR 11 1995
Validation: 1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. Ff.
OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. Ff. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.Ff.GAR ® 3/.c
HOUSE SEWER
LATHING
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 APP.IEOUIP.
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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
09
NAL INSPECTIO
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL