05210 (SFD)TA
f4
P.O. BOX 1504 N o . 05AO
Building 7&105 CALLE ESTADO
Address 77-435 Fernando LA QUINTA, CALIFORNIA 92253
Owner � j
La Qninta .Joint Venture'.
Mailing '
BUILDING:"TYPE CONST. OCC: GRP.
Address P. 0. Box 784 A.P. Number Santa Rosa Cave
City. Zip Tel.
La Quinta. 192253 1 5 4-1315 Legal Description F`
Contractor Project Description Platt B. Tract 14496-4
Address
City Zip Tela
State Lic. City
& Classif. 378318 Lic. # 189, _ . _ sq.,Ft. 3114 No.. No. ;Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
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 Business and Professions Code, and my license is in full force and
effect . ( - . - � ,1
SIGNATURE DATE
OWNEWBUILDER DECLARATION Estimated Valuation
I hereby affirin that I am exempt from the Contractor's License Law for the following $216,509
.
reason: (Sec. 7031.5,Busieess and Professions Code: Any city or county which requires a
permit to construct, after. 6rmrove, dermormsh, or repair any structure, prior to its issuance also
requires the applicant for such perms to tae a signed statement that he is licensed pursuant to PERMIT _ . AMOUNT •i
the provisions of the Contractor's License taw, Chapter 9 (commencing with Section 7000) or
Division 3 of the Business arid Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemptl ri- Any violation of Section 7031.5. by 'any applicant for a permit Plan Chk. Dep-
subjects the applicant to a civil permfly 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 Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. Professions Code: The Contractor's License Law does not apply to an owner of property who 77 n
builds or inproves thereon and who does such work himself or through his own employees, M@Ch.
provided that such unprovements are not intended or offered for sale. If, however, the building {+
orimprovement is sold within one year of completion, the owner -budder will have the burden Electrical
of proving that he did not build or inprove for the purpose of sale.) F*
O 1,as owner of the properly, am exclusively contracting with licensed contractors to torr Plumbing +�
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 inproves thereon; and who contracts for S.M.I.
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 Grading
Driveway Enc.
Date' -0— 1- - owner i - Infrastructure A A 7 1 A
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
O Copy is filed with the city.. O Certified copy is hereby furnished.
t TOTAL 46i505.46
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ll the permit is for one hundred dollars (5100) valuation ,4i!� .�, .r,jt,��i,. {,�.'";t:"'ST.tr`.,,r-r• . •�
or less.) �, !�+ „4'A,.4+r .} i 4.• C Yil. d i+..t .. a�
1 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 APPUCANP ff, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Corrpensation provisions of the labor Code, you must forthwith
comply with such provisions or this permit shag be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
1 hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, CAW Code.) Side Setback from Property Line
Lenders Name
Lenders Address FINAL DATE INSPECTOR
This is a building permit when property filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days. ! L9 p
1 certify that I have read this application and state that the above information is correct.. Issued by: Date ! [ V 9 -Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE �K14-
� ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF. io,v
J (((( b
POWER OUTLET
ROOF DRAINS
GAR. Sp, FT. ®
(FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. Sp. FT.
WALL Sp. FT.
WATER HEATER
DRINKING FOUNTAIN.
FINAL INSP.
URINAL
,. SQ FT ®
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
plus x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
HING ��
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/e c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
HOUSE SEWER
GAS PIPING
PERMITTEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBIa LG ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
fw CV
GROUND PLU BING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE �K14-
� ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. io,v
J (((( b
GAS(ROUGH) �O /JA J
METER LOOPHEATING
(FINAL)
OTHER APPJEQUIP.
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.
FRAMING
FINAL INSP.
ROOFING -7 c
VENTILATION
09
�A/J
u//
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
R. FIREWALL
HING ��
MESH
s�
LATIONISOUND
FINISH GRADING
FINAL INSPECTION a
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL