06951 (SFD)T4'it 4 4Cl"
Building
Orlrlrace 49-065 $alada Court
L3.At1V011 #EVEU)PNOi
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailin
Address 68»713 Perez Road, 01
City Cathedral Cit Zip 92234 Tel -773-5824
Contractor
Address
State Lic. City 21
& Classif. 337077 Lic. #
Designer
Address—T—Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affi t I am licensed' under provisions of Chapter 9 (commencing with.Section
7000) of Divisiii 3 of the Business and Professions, Code, and my license is in fulPforee and
effect.."��%llr9.ri�.•x..Y�/•'
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Busmess and Professions Code: Any city or county which requires a
permit to construct, atter, 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 of the Contractors 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 c" 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 Contractors License Law does not apply to an owner of property who
builds orrnproves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. ff, however, the building
orimprovement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or 'reprove 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 contractor(s) 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 d the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of 019 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. ff, after 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.
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.)
Lenders Name
Lender's Address
This is a building permit when properly 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
ateMailing Address
City, State, Zip
No. 06951
11LDING: TYPE CONST. OCC. GRP.
P. Number
Tract #21555-51, Phase V
Description
t Description PARC LA QUINTA
Plan 1740 W. Lot 022
Sq. Ft. 1 X740 No. No. Dw.
Size Stories Units
New ( Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$88,574
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
494.25
Const.
599. IJ
Mech.
bit. bU
Electrical
02. 60
Plumbing
120.50
S.M.I.
6.23
Grading
Driveway Enc.
Infrastructure
TOTAL
3.373.O f
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB.
2ND FL SQ. FT.
HEATING (ROUGH)
YARD SPKLR SYSTEM
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. Fr. ®
ROCK STORAGE
FOUND. REINF.
GAR. SO. Fr. ®
POWER OUTLET
ROOF DRAINS
OTHER APPJEQUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. I SQ. FT. ®
WALL SQ. FT. @
WATER HEATER
DRINKING FOUNTAIN.
SQ FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP. &f Qo po
WATER PIPING
NOTE: Not to be used as property tax valuation
LUMBER GR.
FLOOR DRAIN
MECHANICAL FEES
o Q
(Y
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, TEMIPERM
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 ®1Vi c
SEWAGE DISPOSAL
INSULATION/SOUND
SO.FT.GAR @ 3Vic
HOUSE SEWER
FINISH GRADING
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 2 Q leW
GROUND PLUMBING &�({ QUNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE Z l5 �d
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
/
ROUGH WIRING Y �%, Ql�
v
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)1— If— a
J
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP. &f Qo po
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING q `l6
[
ROOFING
o Q
(Y
LLL J
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
ING ( 10 j6j
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION Z' d 0
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
'
GARDEN WALL FINAL