06865 (SFD)P.O. BOX 1504 No. 06865
Builin78-105Address 44-1255 Calico Circle LA QUINTACCALIFORNIA 92253
Owner
La Quinta Associates
BUILDING: TYPE CONST.
A.P. Number
Legal Description
OCC: GRP.
Tract 22982 - Phase • V
Cactus Flower}palm
Mailing
Address 43-875 Washington St.
City
D@Ser
Zip
922
Tel.
345-7541
Project Description
Pian 2CR - Lot l34
Contractor
E.G. Williams Dev. Corp.
Address
Same
CityZip
I
Tela
State Lic. '
City
& Classif. 43919
Lia # 1231
Sq. Ft. 1,621
No. No. Dw.
Size
Stories Units
.
Arch; Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
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
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,Busiress and Professions Code: Any city or county which requires a
Estimated Valuation
$87.514
PERMIT
'
AMOUNT
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 hes 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 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, Buisness and
'"Professions Code: The Contractor's License Law does not apply, to an owner of property who
• bud& or improves thereon acrd 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 burdenElectflCal
of proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plan Chk. Dep.
Plan Chk. Bal.
_ • _
Const.,
`539 ♦ :31X
539.
Mech. -
• 90
104
Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who bu8ds 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.0 for this reason
Y? ,y / 1
S.M.I.
d.
Grading
Driveway Enc.
��•~
Dated �f 'd� owner's.] y'� % f.= f
Infrastructure
,�
i
WORKERS' COMPENSATION DECLARATION
her 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.)
I Policy No.Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
^
'.7JtJ.t1V
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(chis section need not be Completed if the permit is for one hundred dofiars ($100) valuation
or less.)
I certify that in the performance 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
REMARKS
t• �.
+ } ��.: t.�f �:"- I,3`I .� � w ;i'-'JvCt . t
Date ' Owner
NOTICE TO APPLICANT: N, 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.
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, axil code.)
Side Setback from Property Line
Lender's 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.
1 certify that I have read this application and state thit 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 orf this city to enter the above-.
mentioned property for inspection purposes.
FINAL DATE
Issued by:
Validated by:
INSPECTOR
� CTO
Date Permit
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE ��% O
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTOIWX�PgrROUGH WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
WATER HEATER
SERVICE
WALL SO. FT. ®
DRINKING FOUNTAIN
FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP. D
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
HOUSE SEWER
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 PLUMBINGELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
7T ;ir
GROUND PLUMBING
91 UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ��% O
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTOIWX�PgrROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS (ROUGH)
METER LOOP
OTHER APPJEQUIP.
REINF. STEEL
00,
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -plus-x$-=$
LUMBER GR.
FINAL INSP. 7_ [6a'>
FRAMING 7 $' 010%
FINAL INSP. D
ROOFING b H Y�
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND G
FINISH GRADING
FINAL INSPECTION 1O a t
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL