14844 (SFD)Building
Address
4
P.O. BOX 1504
78-495 CALLE TAMPICO
45-060 Rate blewoed 'fit. LA QUINTA, CALIFORNIA 92253
I17>yo RCim@s
BUILDING: TYPE CONST:
Mailing
Address 250 E. Rincon Ste. 202
City Zip Tel.
Corona, CA 91719 (909)736-0700
Contractor
5e'>tirme
Address
State Lic. City
& Classif. B 523968 Lic. # 3318
Arch., Engr.;
Designer C • S. A.-
d 3 Sast' tae La Guerra
4051962-45755
City Zip State
Santa Barbara. CA 93101 Lic. # C12.850
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
'7000) of Division.3yrof the Business and Professions Code, and my license is in full force and
effect•Fy^"
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors. License Law for the following
reason: (Sec. 7031.5,Business,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 fife a signed- statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Dlvislon 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 rive hundred dollars (8500).
❑ 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, Suisness 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.)
❑ 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.).
❑ 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
Worker's _Qbmpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy,14 Company.
OCopy is filed with the city. ❑ Certified copy Is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
1 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.
P. Number
Description_
Project Description IFS -Pl.an 4
Reunion at La Qiinta
No. 34844
VN OCC: GRP. R3
Lot 27 Tract 23995-1
Sq. Ft. 2008 No. No. Dw.
Size Stories Units
New O Add I] Alter O Repair ❑
:stimated Valuation $120,912.00
uemontton u
PERMIT
AMOUNT
Plan Chk. Dep.
Distances:
Plan Chk. Bal.
594.65
Const.
713000
Mech.
55; 50
Electrical
145.90
Plumbing
06
138A0
S.M.I.
12.09
Grading
20.00
Driveway Enc.
.00
Infrastructure
2,720.52
Arts 1n Public daces
52.2€1
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:
TOTAL
4,451.94
REMARKS
Date Owner
,NOTICE
NOTICE TO APPLICANT. N, after making this Certificate of Exemption you should become.
ZONE: BY:
to the Workers' Compensation provisions of the Laboi Code, you must forthwith
Distances:
comply with such provisions or this permit shall be deemed revoked. .
Minimum Setback
Front Setback from Cel
Rear Setback from Rea
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Setback f
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 j:
DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND- -
ATroRNErs FEES.
FINAL DATE PE(
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state thatthe above information is correct.
Issued by: Date
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
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. p $
UNITS
COLL. AREA
2ND FL. SO. FT. p
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. p
SEWER OR
GAR. SO. FT. p
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. SO. FT. p
HEATING (FINAL)
OTHER APP./EQUIP.
WALL SO. FT. p
DRINKING FOUNTAIN.
SO. FT. p
URINAL
ESTIMATED CONSTRUCTION VALUATION $
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(AUTO)(DISH)
APPLIANCE DRYER
FRAMING S ,
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
/
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
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. p c
BATH TUB
SO. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID p I 1 c
SEWAGE DISPOSAL
LATHINGAlf1b
SO.FT.GAR p Y4c
HOUSE SEWER
MESH
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 I ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK -
FORMS
SEWER OR
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH) 7 .
7
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATE �(
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
'FINAL INSP. /
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING S ,
ROOFING (
VENTILATION
/
REMARKS:
FIRE ZONE ROOFING r
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHINGAlf1b
MESH
INSULATIONISOUND ell
FINISH GRADING n
FINAL INSPECTION I
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL