05912 (SFD)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 79-585 Rlazlmg Star TYa31- LA QUINTA, CALIFORNIA 92253
L)wner
La QuInta Associates `
Mailing ..
Address 63-875 Washington 8t.
City Zip Tel.
P.D. 92260
Contractor
Sam
City lZip I Tela
State Lic. I City
& Classif. 693919 Lic. # 1231
Arch., Engr.,
Designer
Address I Tel.
City IZip I State
Lic- #
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 Contractors License Law for the following
reason: (Sec. 7031.5,E 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 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 the applicant to a civilpenally of not more than rive hundred dollars ($500).
❑ 1. a.1
Zr 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 Contactors 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 ore year of completion, the owner -builder will have the burden
of proving that he did not build or krprove 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 contacts for
such projects with a comractorrs) 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, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
;O 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 perlomtance of thg 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: fl, 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 (Iris 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
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 certify that I have read this application and state that the above information is correct.
1 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. 05912
BUILDING:"TYPE CONST. OCC: GRP.
A.P. Number
Legal Description Phage 11 Lot 50
Project Description Plan 4C CAct 3 P2aw>~
Sq. Ft. 1887 No. No. Dw.
Size Stories Units
New ® Add ❑ Alter ❑ Repair ❑ Demolition ❑
o-
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Estimated Valuation
88,50i�.c?0
Rear Setback from Rear Prop. Line
PERMIT
AMOUNT
Plan Chk. Dep.
Side Setback from Property Line
Plan Chk. Bal.
494.40
Const.
590.00
Mech.
53.50
Electrical . " -
113.71
Plumbing
123.00
S.M.I.
6.23
Grading
Driveway Enc.
Infrastructure
2221.98
TOTAL 3602.9,82
C. . "�. IZ10"
REMARKS
<`ii{,t.7:4 ?+,t#J +:]! t •% ti 7 dsir:++ ,:. v .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 6-15-99 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. ® $
UNITS
SLAB GRADE �r
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. F7, ®
GAS (ROUGH) If
ER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) ��
Illy ,
P. POLE
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE Not to be used as property tax valuation
FRAMING 7 f
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
INSULATIONISOUND
SO.FT.GAR ® bac
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 PLUMBIrN�^ 4,. ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE �r
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. '7 �V
GAS (ROUGH) If
ER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) ��
Illy ,
P. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. 1 (�
FRAMING 7 f
a FINAL INSP.
ROOFING �V (
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING /,/
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINTTIALS
GARDEN WALL FINAL