05161 (SFD)TWIf 4 4 aaki
P.O. BOX 1504
No. 05161
Building •+ 78-105 CALLE ESTADO
Address 44-210 Calico Circle LA QUINTA, CALIFORNIA 92253
Address
City Zip "'' Tel.
Yale Desert 92060 345-7541
Contractor
E. G. Williams Developuent Corp
Address
City lZip I Tel. -
State Lic.Gity
& Classif: -493919 Lic. #
Arch., Engr.,
Designer
Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70011) of Division 3 of the Business and Professions Code, and my license is in full force and
effect
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I huffy affirm that I am exempt from the Contractor's License Law for the following
reasorr (Sec. 7031.5,8uskuess and Professions Code: Any city or county which requires a
pemrft to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such penal to We 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 civil penalty of not more than five hundred dollars ($500).
❑ 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
brills or inproves thereon and who does such work henself or through his own employees,
provided that such inprovements are not intended or offered for sale. lf, however, the building
or krprovernent is sold within one year of completion, the owner-bueMer wig have the burden
of proving that he did not buftd or enprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to corn
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 protects 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
WORKERS' COMPENSATION DECLARATION
hereby affirm that I 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
`Ci Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need riot be completed B 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
aliforniaDateOwner
NOTICE TO APPLICANT: ft, after making this Certificate of Exemption you should become
sub)ect 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 abuilding permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity 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
LDING:, TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Plan 3CR, Lot 125
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 1J�'/8Permit
Validated by:
Validation:
Sq. Ft. 1633
Size
,No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
SR6 925
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
g1139-25
Const.
Mech.
{>�
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
9.5 1 56
TOTAL
R � -4 tn
{
_.ti
REMARKS
LV
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 1J�'/8Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. a $
UNITS
LAB DE 2�
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWER OR SE C"TA
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. a
GAS (ROUGH)
METER LOOP
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)G
P. POLE
DRAINAGE PIPING
CAR P. SO. FT. a
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SOFT a
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used aS property tax valuation
FRAMING �
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.C.00L HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SO. FT. a c
BATH TUB
SO. FT. a c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a 1% c
SEWAGE DISPOSAL
INSULATIONISOUND
SO.FT.GAR a V4c
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 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
UNO PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
LAB DE 2�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SE C"TA
ROUGH WIRING
DUCT WORK
ROCK STORAGE
U . EINF. �T /
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)G
P. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. aee
FRAMING �
INSP.
OFING�/
G
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL