05224 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 50-365 onito -LA QUINTA, CALIFORNIA 92253
Owner
Mailing - - -
Address P. 0. Box 366
City Zip Tel.
La Quanta 92253 564-4832
Contractor
Address
Tela
State Lic. I City
& Classif. 437584 Lic. #
Arch., Engr.'
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensectunder 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. 3 A
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 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
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenalty of not more than rive 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
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 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.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date & Owner
WORKERS' COMPENSATION DECLARA lo�l,�
I hereby affirm that I have a certificate of consent to eff-insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereo . V.
3800, Labor Code.)
Policy No. Company �y%'
❑ Copy is filed with the city. ❑ Certified copy is hereby urnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
Of less.)
I certify that in the performance of the work for which INermit is issued, I shall not
Laws of
employ any person in any manner so as to become subjec} issued
Compensation
DCalifornia. [t//
ate Owner
NOTICE TO APPLICANT: If, after making this Certificate 6/1,Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No.
11LDING:.TYPE CONST. OCC: GRP.;
P. Number 769--074-009
Legal Description
Project Description S • F.D.
05224
ZONE: BY:
Minimum Setback Distances -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 12%30/$Permit
Validated by:
Validation:
Sq. Ft. 2226.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
C7
PERMIT
AMOUNT
Plan Chk. Dep.
A
Plan Chk. Bal.
C n
Const.
A R P
Mech.
-4-1 nn
Electrical
C
Plumbing
1 nn
S.M.I.
Q q1
Grading
10 nn
Driveway Enc.
WI
Infrastructure
7 66A. AR
TOTAL�A
C fi
E! ^'. r • z�.� % ;�
REMARKS
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 12%30/$Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL SO. FT.
ROUGH PLUMB.
or-
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ —Plus—X$—=$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEM/PERM
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 ® 1Vi c
SEWAGE DISPOSAL
SPARK ARRESTOR
SO.FT.GAR ® 314c
HOUSE SEWER
GAR. FIREWALL
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
or-
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
'L—
SEWER ANC AN
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP.
FR ING �Z�Y / �
FINAL INSP.
FING 3/`�
i .l t �� <%j'
(�� % ^-� "✓/
( /
c
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
(j LATHING ` '
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION _
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
UI i l(,E or
AGRICUL 1 URAL COMMISSIONER
AND
WI:IGI I Is b. HEINSURLS
49-613 Ilwy 06, "tilt e II -12
•C0.1101elln, CA 92236
619-342-0291
D11'1'E �c e 13 ,R CASC I IU.
E. LEON SPAUGY
la;u)'All
JAMES CI WALLACE
ASSIS(A\t � �)'•1'•11SSIl)�f.l!
UELEME-41i BUNVENISIE
q.attn
UEVE orni's WMC
AUUIsEss t P v x x 3� -
�`rst(-� CI.,. .\ r,�c job S' t� ( a �l �t � (o142
(fp"Uz 0-,4- j 4,0
Dear Uevelopert
After reviewing your landscovi.11y plahsr 711 plant nyterial listed is 'lot i.n
violation of quarantine 1j1�►s. (JOVetiliny elle Coachella Valley. IE :;ubstitutivns
do occur and they differ [rcm plant nvaterial listed, tills office Idlust• be notified
itlillediately.
'1'Itautic you, Cor pivtectilly slid preserving the Coachella Valley's peat -tree envirotellent.
1
Agr l lural Caullissioiierl s ul E ice
cct Indio attd Riverside U[Eice