14769 (SFD)t P.O. BOX 1504 No. 34769
Building 78-495 CALLE TAMPICO '
Address 44"330 f'ai!liAo La3 Anda LA OUINTA, CALIFORNIA 92253
Owner Century. 13omes ' Co=uunities
BUILDING TYPE -CONST - OCC_ GRP' R
Mailing "
Address 1535 South ADO Street, ate. 200
City Zip ITel.
San,- Bernardino eA 92408 (909) 381.-5007
Contractor
Same .
Address
City lZip I Tel.
State Lic. City
& Classif...B 3,14473', Lic. # 2120. '
Arch:, Engr.,
-Designer J?r"I fionzai ies & Assoc. xch.'
..
ty ms F4st' "C kip pm an AVe, Tel. 532-6$78
City Zip State
£31`�ttge;"C..A, 92666 Lic.#
LICENSED, CONTRACTOR'S DECLARATION
i I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full. force and
•.Jeff$ct.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following,
reason: (Sec. 7031.5,81usiness and Professions Code: Any -city or county which requires a
permit to construct, atter, Improve, demolish, or repair any, structure,. prior to, its issuance also
requires the applicant for such permit to rile 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
'tor 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 ($500). -
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 of completion, the owner -builder will have the burden - -
of proving that he did not build or improve for the purpose of sale.) -
O' 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 affGn'that I have a certificate of.consent -to self -insure, or a certificate of
Worker'spensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy Nd.'- Company
.opy.is•filed with the city, ❑ Certified copy Is hereby furnished.
A.P. Number
Legal Description Lot 1,48 Trod: 2'5290 Phase IIA
Project Description
Rancho.Ocotillo @ La Quinta'i, Norte -
Sq. Ft. 1.905 No. No: Dw.
Size Stories Units
New ❑ Add O Alter ❑ Repair ❑ 'Demolition 0
CERTIFICATE OF EXEMPTION FROM
'
REMARKS
• WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one .hundred dollars ($100) valuation-
aluation-'or
'orless.) - -
Estimated Valuation 1I6, . 25.00
ti ".:.PERMIT
AMOUNT
Plan Chk. Dep.
employ anyperson in any manner sous to become subject to the Workers' Compensation
Laws of California
Plan Chk. Bal.
534.85
Const. '-.
699.00
Mech.
55.50
Electrical
140.7
Plumbing
144.00
S.M.I.
11.60
Grading
20.00 .
Driveway Enc.
00
Infrastructure
2,,S60.29
Ars in •171. c Places
40.06
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,-
Side Setback from Property Line
TOTAL
4.256.03
CERTIFICATE OF EXEMPTION FROM
'
REMARKS
• WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one .hundred dollars ($100) valuation-
aluation-'or
'orless.) - -
I certify that in the performance of the work for which this permit is issued, I shall not
employ anyperson in any manner sous to become subject to the Workers' Compensation
Laws of California
" Date Owner
_ NOTICE TO APPLICANT: B, after makirig this Certificate' of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith '
comply with such provisions or this permit shall be deemed revoked.
M InIR1Um Setback
DlStanCBS:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
-
Side Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,-
Side Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
FINAL DATE
INSPECTOR
This is a building permit when property 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.
Issued by:
Date Permit
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.
Validated by:
Signature of applicant —Date—
ateMailing
MailingAddress
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. I SQ. FT.
OTHER APPJEQUIP.
REINF. STEEL
WALL SQ. FT.
GAS (FINAL) TEMP. POLE
DRINKING FOUNTAIN
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
t
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRYTRAY
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.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
INSULATION/SOUND
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 // TRICAL HEATING & AIR COND. SOLAR
� x f{�t
SETBACK
_GROUND PLUMBIN UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
(y
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SE ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER I V SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING /
FINAL INSP.
ROOFING
t
loaf
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL