03915 (SFD)P.O. BOX 1504
Building -78-105 CALLE ESTADO
Address 5,2 425 Avenida i'3ermu.3aa s LA QUINTA, CALIFORNIA 92253
Owner
y Vextern Amc .cican con's'truction "co
UILDING:-TYPE CONST'6 ' ' OCC. GRP.
`—
Mailing
Addre?s' . P. Q. Box 1379
"173-275 -019
-'
A:P'Number
Legal Description
City
Ila Quanta
Zip
92253
Tele -
504-7411 . _
•
.'v
Const.
Fart ily Hmlling
3 • tr O
ContractorSingle
Gary Reynolds -
P«oject Description
Address
Electrical
Fs Q. BOX 807
City
ip
r
Tel,
3G0flin Palmer
9:276
343-2671
Grading
State Lic.
City
Driveway Enc.
& Classif. 469157
Lic: # 1114 -
,Sq. Ft. 1330 No. ,. No. Dw.
!#S:92.04
Size Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City Zip State
Lic. It
LICENSED CONTRACTOR'S DECLARATION {
I hereby affirm that'l 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. 4=4_t_� lr ! ✓ 7 �% 11, f tv j r
SIGNATURE,DATE
r
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,81usiness 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 Cade, 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 (5500).
0 1, 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 that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year cf completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
0 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.)
O 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 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 the 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
,timated Valuation
$70,1,757
PERMIT
AMOUNT
Plan Chk. Dep.'
•
_
Plan Chk. Bal.
•
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Const.
3 • tr O
Mech.
_� +
Electrical
/
Plumbing�.if
S. M. 1.
4 . V 4t
Grading
2o •i�i�
Driveway Enc.
Cox • 00
Infrastructure
!#S:92.04
TOTAL
�� •'
t'
REMARKS
19F1H i lal It rtitC/ , �9ri-'? fi itQ f j
k'v ;,r+asi a 11kfr1S. t :«rvie.r
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:
F4 WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATL I NO. I ELECTRICAL FEES ' NO. I PLUMBING FEES
IST FL SO F1 y S
UNITS
UND PLUMBIN�/,_,-
UNDERGROUND
YARD SPKLR SYSTEM
2ND FL SO FT. 0
SLAB GRADED
ROUGH PLUMB
MOBILEHOME SVC.
BAR SINK
POR SO FT or
STORAGE TANK
FORMS
POWER OUTLET
ROOF DRAINS
GAR SO. FT. 0
DUCT WORK
ROCK STORAGE
/
FOUND. REINF./n
.
DRAINAGE PIPING
CAR P. I SO FT. 4V
METER LOOP
HEATING (FINAL)
WALL SO. FT. a
REINF. STEEL
DRINKING FOUNTAIN
GAS (FINAL)
URINAL
SO FT a
GROUT
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE, Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOKDISHI
APPLIANCE DRYER
LUMBER GR.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FRAMING 1 -` �y^J �,' /�j%
�' i r
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.
SO. FT. ® c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID ( 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR-
SO.FT.GAR 4e 3/c
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
UND PLUMBIN�/,_,-
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADED
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR S X
ROUGH WIRING -
DUCT WORK
ROCK STORAGE
/
FOUND. REINF./n
.
/ 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.
S plus xE
=S
LUMBER GR.
FINAL INSP.
FRAMING 1 -` �y^J �,' /�j%
�' i r
FINAL INSP.
ROOFING
I
ddd
p�
V
V
((�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR-
GAR. FIREWALL
- 6
WI—T
MESH
INSULATIONISOUND
�a
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL