07-2193BUildinggr�—
Add:essJ r
Address
T44T
" 07-,;?LIg3
P.O. BOX 1504 APPLICATION ONLY
L 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 7C Z r 360
lN�
Address
-7A-iS7)
0
& Classif. I Lic #
Designer
LA UINTA I gZZ53 ILII. #
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 Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I 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 or county 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 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
III!? 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, Business and Profes-
sions 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 im-
provement 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 of sale).
O I, as owner of the property, am exclusively contracting with licensed contractors to construct
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
WORKER'S 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. 0 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 person in any manner so as to become subject to Workers' Compensation Laws of
California.
Date Owner
NOTICE TO APPLICANT. If, 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.)
Lender's 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 Address
City, State, Zip
WHITE = BUILDING DEPARTMENT
Legal
Project Description
Lam 30 7 a9 /47-1
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:
Validated by:
Validation:
Date Permit
YELLOW = APPLICANT PINK = FINANCE
Sq. Ft.
Size
No. No. Dw.
Stories Units
New jkQ Add ❑
Alter ❑ Repair ❑ Demolition ❑
A99ty Z
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
11j 4'
Grading
Driveway Enc.
Infrastructure
q
of rq
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:
Validated by:
Validation:
Date Permit
YELLOW = APPLICANT PINK = FINANCE
APPLICATION.#. ADDRESS BY
. VAL.UATION , SQ . FT'.
at , :; ;: Zi
1: FLOOR 3..3
COVERED PATIO
GARAGE ' I -21
CODE EDITION. tae c IZc�S
ROOF- TYPE Tac
MECHANICAL
# VENT FANS
# EXHAUST HOOD
A/C •<3 ' TON
A/C >3 TON
FAU <100, 000 BTU
FAU >100,000 BTU P
DUCT ALTERATION
PLUMBING
# OF FIXTURES
SEWER ,
SEPTIC SYSTEM
ROOF DRAINS
WATER HEATER
WATER PIPING
LAWN SPRINKLER
GAS PIPING 1-4
GAS PIPING. >4 .
GAS . METER ,..
DNIT COUNTS../ GAS
.TOILETS
BIDET
SHOWERS
BATHTUBS
SINKS
BAR ' S INX
BBQ.
OVEN
RANGE.
COOKTOP
DRINKING FOU]
WASHER.*
DRYER-'-
'WATER,-HEATER
RYER '-
WATER -HEATER
ROOF -DRAINS
FLOOR DRAINS
.KITCHEN SINK
VEG SINK
LAUNDRY SINK
FIREPLACE
ELECTRICAL
SQ . FT LIV
GARAGE- SQ . FT t,z.q/
TEMP=POWER
FIXTURE #.
REQUIRED I NSPE.CTI-ONMA1 NTE.- .
TEMP POWER
SEINER CONNECTION
UNDERGROUND ELECTRICAL
UNDERGROUND GAS
UNDERGROUND MECHANICAL
VNDERG;ROUND PLUMBING
ww
TEMPLATE FOOTI N G
DRYPAC-K
GRA DE.BEAM
.:, :... FQOTI:NGS
v SLAB:: -
ROOF. NAIL
:OKAY TO- WRAP
FRAMING
°ROUG:H -ELECTRICAL
ROUGH` MECHANICAL
ROUGH:PLUMBING
SHOWER PAN
INSULATION
LATH
DRYWALL NAIL
GAS LI N E- / GAS TEST
TEMP VSE OF PERMANENT POWER
'.CDD RNAL
PUBLIC WORKS FINAL
ELECTRICAL FINAL.
MECHANICAL FINAL
PLUMBING FINAL
'GRADING FINAL
FINAL
AQM D FINAL
BOND .BEAM
CODE COMPLIANCE .FINAL
CVWD FINAL
FIRE DEPT FINAL
FLOOR. NAILING
GREASE INTERCEPTOR
HEALTH DEPT FINAL
PIERS ,
PRE -GUN ITE
PRE -PLASTER
PRE -ROOF'
PRE -SITE .. :. .
ROOF: , l;N
SEPTKABANDONMENT
SEPTIC:SYSTEM-
.. SPEC.lAL:INS.PECTI`ON.
T -BAR
WATERLINE.