06941 (SFD)P.O. BOX 1504
Building 49-220 Bajada Court 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
BARC011 DEVEL P14ENT
Address 58-713 Perez toad, #1
City Cath .edral Cit `•ip 92234 Tel. 77.
Contractor
Address
State Lic. 337£i7 City 1219
r£ Classif. Lic. #
Arch.- Engr.-,
Designer
Address Tel.
City Zip State
_ Lic. #
,,r1.10ENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing,viith Sec)ibn
7000) of Division 3, of the Business��a�nnd Professionsmy
siyCode, and�license isj�in full force and
effect ls/ <%. �Jrie :✓.!!y%�!' �l:l%✓G
SIGNATURE f f DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Ole 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 civilpenally of not more than Ove 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 Conbactors 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
orion rovement is said 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 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 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 1 have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, ora 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 If the permit is for one hundred dollars ($100) valuation
or less.)
1 certity 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
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 y
Lenders 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 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 Address
City, State, Zip
No. 06941
ILDING: TYPE CONST. -,OCC,. GRP.
'. Number Tract 921555-5, Phase V
Legal Description
Project Description PARS LA QUINTA
Plan 2222 (D), Lot. #12
Sq. Ft. 21222 No. No. Dw.
Size - - Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Ir
Estimated Valuation $112,151
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
571.10
Const.
W5.00
Mech.
60,00
Electrical
120.79
Plumbing
144.50
S.M.I.
7,91
Grading
Driveway Enc.
Infrastructure
2, 523.63,
r
s
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 Permit
Validated by -
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL SQ. FT.
b I< 1<
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
SEWER OR SEPTIC TANK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
DRAINAGE PIPING
WALL SD. FT.
HEATING (FINAL)
DRINKING FOUNTAIN
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
CU. yd.
$ -plus-x$_=$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP. Z
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
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 Q
A(
GROUND PLUMBING 0[
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 3
b I< 1<
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) //�
C
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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. Z
FRAMING [ (q 10
FINAL INSP.
ROOFING
3l" ?O
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
L,
LA HI G J�(/
MESH
INSULATIONISOUND
FINISH GRADING
p
FINAL INSPECTION p R
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL:d
k