9625 (SFD)T4ht 4 4 Qum&
Building 18-600 Carnes Circle
Address
Owner
Mailing
Address 1021 Rastanchury Roa,
City lZip –TT—el-
Contractor
Address
Zip I Tel.:
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST
A.P. Number
State Lic. City
& Classif. B 2923954 Lic. # 1612
Arch., Engr.,
Designer
Address Tel.
City Zip State
I I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that'] 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 71
DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county Which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance afso
requires the applicant for such permit to file 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 Mat. he is exempt therefrom, and the basis
'for Lthe 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 ($500).
0.1, as owner of the property, or my employees, with wages asTtheir 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. ff, ho"vef, the building
or Improvement Is sold within one year of completion, the 'owner-bullder 'will have the burden
of proving that he did not build or Improve for the purpose of sale.)
0 1, 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 contractoris) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec.—B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby 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.),
Policy No. Company
0 Copy is filed with the city. D.Certified copy is hereby furnished.
CERTIF16ATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or /a..)
I certify that in the performance of thp work for wfilch,this permit is issued, I shall not
any person in any manner so as to become subj9t to the Workers' Compensation
California:
Date "2t—flOwner I -
NOTICE TO APPLICANT. If, after making this Certificate of EKemption 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 perrn�it is issued. (Sec. 309 7, Civil Code.)
Lender's Nam
Lender's Address
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 car tify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinarfces 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. 9625
Legal Description Lot 62
Project Description Plan C2
OCC. GRP.
ZONE: BY:—
Minimum Setback Distances:
Front Setback from Center Line
Rear S - etback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE —INSPECTOR
Issued by: —Date_Permit
Validated by:
Validation:
Sq. Ft.
Size 1927
No.
Stories
No. Dw.
Units
New 0 Add 0
Alter 0 Repair 0 -Demolition 0
Estimated Valuation
105,733
PERMIT
AMOUNT
Plan C6k.'lDe'p,
Plan Chk. Bal.
bb2 . ou
Const.
bbo. 50
Mech.
bU7 OU
Electrical
114.47
Plumbing
144..50
S.M.I.
7. 42_
Grading
Driveway Enc.
Infrastructure
237ti. 99
Ar,ts -in Puoli c
U U
AW;iWl 46
',A*
%
&A� LSA" I
U I AL -1. XM2. ORD
TOTAL
REMARI�S,
ZONE: BY:—
Minimum Setback Distances:
Front Setback from Center Line
Rear S - etback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE —INSPECTOR
Issued by: —Date_Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. @ $
UNITS
COLL. AREA
2ND FL SO. FT, @
YARD SPKLR SYSTEM
POR. SO. Fr. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. @
DUCT WORK
DRAINAGE PIPING
WALL SO. Fr. @
I
DRINKING FOUNTAIN.
SO. FT. @
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
-cu. yd.
$ -plus-x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INS�0/�Jj
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEWPERM
LAVATORY
HEATING SYST�M- FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. @ c
BATH TUB
FIRE ZONE ROOFING:
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U,
SO. Fr. RESID @ I V4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERM FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT.FEE
PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR -
SETBACK A
GROUND PLUMBING - 21 UJUNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPTIC TA id ROUGH WIRING.
DUCT WORK
ROCKSTORAGE
FOUND. REINF. AM
GAS(ROUGH) c METER L60P
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 INS�0/�Jj
FRAMING
FINAL INSP.
ROOFING
ov
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
11. ' fliC
'UTHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL