06942 (SFD)4
P.O. BOX 1504 No, 06942
Building49,.250 Balada Court LA QUINTA, CALIFORNIA 92253
Address
Owner
RCON DEVELOPIi1T
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description
OCC. GRP.-
Tract #21S55 -S, Prase V
PARC. 1.A QLItMTA
Address - 68-713 Perez Road, #1
City Cathedral Ci
?;+p 92234
Tel 773-902
Contractor
Plan 1804 8) Lot #13
Address
City
Zip
Tela
State Lic.
City
& Classif. 337077
Lic. # 1219
Sq. Ft. 1,80.4
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New iX Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LfcBism CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section
7000) of bivis!on 3 of the Business=and Proofesssiions' C/od�e, and my licens ='s in full force and
effect �'� A,0, r /�,%� r/i/'-,cmc cr �� j,/��'
SIGNATURE 7DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Brrsiness and Professions Cade: Any city or county which requires a
permit to construct, after, improve, denxiish, or repair any structure, prior to its issuance also
requires the applicant for such permit to lie a signed statement that he is licensed pursuant to
Me provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Divisbn 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 Man 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: flee Contractors 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 irprovements are not Intended or offered for sale. If, however, the building
orimprovement is sold within one year of completion, Me owner -budder will have the burden
of Provos that he did not build or improve 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) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Estimated Valuation
X93 604
=
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
cc� C3
u 2.50
0
Mech.
q
�G. 5ii
Electrical
106.56
Plumbing
138.50
S.M.I.
�:
Grading
Driveway Enc.
Date Owner
Infrastructure
2,105.09
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 furnished.
Q�
TOTAL-
3, 5;3
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the perforolance 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.
REMARKS
_
{ f4 if 1« t L �I f IIA
Date Owner
NOTICE TO APPLICANT ff, after making this Certificate of Exemption you should become
subject to the Workers' Conpensation provisions of the Labor Code, you must forthwith
Comply with such provisions or this pemvt shag be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civet Code.)
Side Setback from Property Line
Lenders Name
FINAL DATE
Issued by:
Validated by:
INSPECTOR
Date Permit
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration it 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
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE A
YARD SPKLR SYSTEM
r
2ND FL. SQ. FT.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
SEWER OR SEPTIC TANK
ROUGH WIRING.
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. I SQ. FT.
HEATING (FINAL)
WALL SQ. FT.
REINF. STEEL
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FRAMING Y3/lo Q yr
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
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 p
GROUND PLUMBING O 1
w UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE A
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) //6 a
!!!!!! ((
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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. G
FRAMING Y3/lo Q yr
FINAL INSP.
ROOFING
D �/
9 cy P-1
C w
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA HIa R O If W
MESH
INSULATIONISOUND !� C
FINISH GRADING
FINAL INSPECTION
a
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL