07473 (SFD)fyy ,s i
Address' 79"820 St Ift
Owner
Address 12IS26 H10h Bluff
City
ZIP
s'm D ®
92104
Contractor .
-
l3
Address
^.f.,
City
Zip
State Lica
& Classif. 31()686
'. Arch.., Engr.,-
Designer
Address
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J
City
Zip
t
40 h
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P.O. BOX 1504 No. 0747
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: :TYPE CONST. • OCC: GRP..
suit 2s A.P. Number /I'/�iv.rd�► f
Tel: '. Ci $ Course Lot 3b . '
`
Legal Description - •
Project Description TT`aet 24290 Pian 3$
Tela
City. .
Lic. #' . M Sq. Ft. 2747 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ : • Demolition ❑
Tel.
State
Lic.'#,.
I hereby f, i that I.Jam licensed urfde' rovision of Chapter 9 (commencing with Section
X00) of D Q y� of t�Se�Business an di P�rSfesslnsCode, and my license is in full force and
OWNER-BUILgER DECLARATION
( I herebkruct,
ffir, that I am exempt from the Contractor's License Law for the following
reason: (Se703 .5,Business and Plessions Code: Any city or county which requires a
permit:to co alter, improve, demolish, or repair any structure, prior -to its issuance also
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 that. he is exempt therefrom, and. the basis
/or 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).
❑ 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.
,.
buildsor, Improves thereon and who does such work himself or through his own employees,
-provided that 4such improvements are not intended or offered /or sale. I/, however, the building
,or impiovement:is sold within one year of completion, the owner -builder will have the burden
r:ti_ o/ prov(ng that he did not build or improve /or the purpose o/ sale.) .
❑ 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 o/ 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 I have a certificate of consent to self -insure, or a certificate of
Worker's Cor)) a ation Insurance, or a certifiYedEgco�D•y. thereof. -(Sec. 38Q0. L boSKI) �✓ r^
Policy `J Company Jae�9���i4ra i ! )� �tf �A►
❑ opy is filed wit 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 IS 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
NOTICE TO APPLICANT. If, 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, Civil Code.)
Lender's Name
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 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
ZONE:
BY: "
Minimum Setback Distances:
r .
Estimated Valuation
$20s494
PERMIT=
-AMOUNT
Plan Chk. Dep.,,
2755.00
'INSPECTOR
Plan Chk. Bal.
.791; -
Const.
Validated by:
.00~
Mech.
Validation:
MAD ...
Electrical
129,67
Plumbing
156.54',
S.M.I.
07 " .t.
Grading
Rt
Driveway Enc.
Infrastructure
. TOTAL
1 16.682 ,15
1 fwu, a•
REMARKS
:.j -267o. -AA -.0%
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/2/9Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL.' SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SEWER OR SEPTIC TA
LAUNDRYTRAY
AIR HANDLING UNIT CFM
DUCT WORK
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.
SQ. FT. ® c
BATH TUB
TEMP. POLE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
FINAL INSP.
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 PLUMBIN 9V
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADED
'1�
ROUGH PLUMB645
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TA
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) Cj�
[[
U METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
!! O114
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-
_$
LUMBER GR.
FINAL INSPt O
FRAMING (Q / 9Ci
FINAL INSP paer>
ROOFING
S
��v �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
c�
INSULATION/SOUN -- 1
d
FINISH GRADING
FINAL INSPECTION L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL