06589 (SFD)-t4
4
P.O. BOX 1504 N O . 06589
Building 78-105 CALLE ESTADO
Address 44--'030 Carman Place, LA QUINTA, CALIFORNIA 92253
Owner F
Trifid Faelfie Da$8)Ct I)18K.# BUILDING: -TYPE CONST: OCC: GRP.-
Mailing I!r:/- is/ / - 004bAddress 74-923 H*vle ##1130 A.P. Number La Ouinta ElAhla>ndsg Tl" 23259
City
False DensrtZip .Tel. 2260 -:340-91-14 Legal Description
ContractorProject Description Pla2i A—R. Lot 17
Address . .
City Zip Tela
State Lic. City
& Classif. 505699 Lic. # 13$3,. , _ _ Sq. Ft.. 14.00 No. No. Dw.
Arch., Engr.,
Size _ Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition'❑
Address Tel.
CityJZip State
rF Lic. #
LICENSED CONTRA;CTOR'S DECLARATION
I hereby affirm that I am°licensed: under Provisions of Chapter 9 (commencing with Seption
70pp) of Division 3 ofyythe Business and /P/roffees-siowCode, and my liter(se ais.in-f6liifoercee and
effecI. . . lR ({ •T 1� /R'1,1r4 f W7 5.t�.' .f
SIGNATURE r: v DAT
rr OWNER 61.11 ER DECLARATION
I hereby affirin that I am exempt from the Contractors License Law for the following
reason:. (Sec. 7031.5,Busfness 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 Bea signed statement that he is licensed pursuant to
the provisions of the Contractors 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 penally of not more than five hundred dollars ($500).
O 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 notapplyto'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
.Y r or improvement is said 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 corm
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who bolds 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 affirm that 1 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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($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
Date Owner
NOTICE TO APPLICANT: ff, 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.
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, Civet 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 certify 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
IEstimated Valuation $78:627
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
458.50
Const.
565.00
Mech.
60.00
Electrical
&
Plumbing
IZ005U
S.M.I.
5.53
Grading
Driveway Enc.
Infrastructure
19 7 6 9 •
I
TOTAL
t3r,053.42
REMARKS
-,., P..,- I., r n-Ytf-` -1 4
}} {.
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 10/2518ftPermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE (I (
YARD SPKLR SYSTEM
2ND'FL. SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROCKSTORAGE
FOUND. REINF. l/ ✓�'
ll
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WALL SO. FT. ®
WATER HEA R
DRINKING FOUNTAIN
FINAL INSP.
URINAL
SO FT ®
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING Z, 1 %lcw
FLOOR DRAIN
MECHANICAL FEES
��
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL 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. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% 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 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUM44G
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE (I (
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF. l/ ✓�'
ll
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
y� TEMP. POLE
GROUT
WATER HEA R
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
-cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING Z, 1 %lcw
AL INSP. �l L
ROOFING ��j/ jQ'�%
��
�y+
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING J9(L")
MESH
INSULATIONISOUND 2 •1 (�
FINISH GRADING
FINAL INSPECTION Cl al L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL
1.