13481 (AC)T4.hf 4 4 Quba
P.O. BOX 1504
Building 56-140 PGA Blvd. 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner K.S.L. Recreation Corporation I
Mailing
Add ress Same
City ip Tel.
La Quinta, CATz 92253 564 1088
Contractor
Bob Edwards Construction
I�IdTy3 PeCOS plaCe
City Zip Tel.*
Indio, CA 92201 775-7933
State Lic. City
&CIassif. B 684857 Lic. # 3212 -
Arch., Engr.,
Designer Automated DeSign Technologies
Ad6r; ss Tel.
4 Z Aca:cia Road West 1 320-5614
City dZIp State
Palm Springs A 92262 1 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am -licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of,the Blusiness and Profe6sions Code, and my license is in full fo(ce And ,
effect.
SIGNATURE 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, after, 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
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civilpenalty ofnot more than five hundreddollars ($500).
0 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 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 su h 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.)
El 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 contractor(s) 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. 0 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 thp 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 cer tify 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
con a truction, 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.
WING: TYPE CONST. OCC . GRP.:
P. Number
Legal Description
Project D . escription Sales Mlodel Addition
REMARKS
ZONE: BY:
Minimum Setback Distances:
Frbnt Setback from Center Lin
Rear Setback from Rear Prop. Line
—Side Street Setback from Center Line
—Side Setback from Prop"erty Line
FINAL DATE INS
Issued by:—
Validated by:
Validation:
Date
E3y_
I
Sq. Ft. 300
-Size -
No. No. Dw.
Stories Units
New 0 Add 0
Alter 0 Repair 0 Derriolition 0
Estimated Valuation
$22,200.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
152.10
Const.
234.00
Mech.
21.00
Electrical
25.50
Plumbing
.00
S.M.I.
2.22
Grading
Driveway Enc.
Infrastructure
TOTAL
434.82
REMARKS
ZONE: BY:
Minimum Setback Distances:
Frbnt Setback from Center Lin
Rear Setback from Rear Prop. Line
—Side Street Setback from Center Line
—Side Setback from Prop"erty Line
FINAL DATE INS
Issued by:—
Validated by:
Validation:
Date
E3y_
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
I ST FL. SO. FT. @ $
UNITS
COLL. AREA
n ft
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. So. FT. @
DUCT WORK
ROCK STORAGE
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. @
GAS (FINAL)
TEMP. POLE
WALL SO. FT. @
DRINKING FOUNTAIN.
GROUT
WATER HEATER
URINAL
SO. FT. @
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
4
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET2
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
GAR. FIREWALL
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT.FEE
SMIFEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
04B GRADE -,IJ- 17 1(
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
OUGH WIRING
DUCT WORK
ROCK STORAGE
4&OUND. REINF. 5�-1/1!
GAS(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BONDBEAM
WATER SYSTEM
$—plus—x$—=$
GRADING
cu. yd.
LUMBER GR.
A 'If
FINAL INSP.
4kFRAMING
FINAL INSP.
/// ROOFING 5e—
WA --
VENTILATION
4
111A
cx
REMARKS:
-
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
&KINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL