05202 (SFD)4
P.O. BOX 1504
Building 7&105 CALLE ESTADO
Address 77-060 Avenida-_Ffernando LA QUINTA, CALIFORNIA 92253
v.. y La Quinta Joint Venture
Mailing
Address P. 0. BOX..7$()
City Zip Tel.
La Quintal 1 92253 1 564-1315
Barril.a Constructi
Address .
Tela
State Lic.I City '►
& Classif. . „ Lic. # .
Arch., Engr.,
Designer
Address I Tel.
City IZip I 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. —41
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirin that I am exempt from the Contractor's License Law for the following
reason: (Sec, 7031-5,8uSress and Professors Code: Any city or county which requires a
permit to construct, alter, irprove, demolish, or repair any structure, prior to its issuance also
requires the appTCant for such permit to file a 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, a That. he is exempt therefrom, and the basis
for the alleged exerrption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects owner
applicant to a cni penary of not more Man five hundred dollars (t500).
O I, as wner 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, Suisness and
Professions Code: The Condradoes License Law does not apply to an owner of property who
builds or krproves thereon and who does such Mark himself or through his own employees,
provided that such improvements are not intended or offered for safe. If, however, the building
or improvement is sold within one year of completion, the owner-buider will have the burden
of proving that he did not build of inprove for the purpose of sale.)
p`I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sea 7044, Bsiness and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or irproves thereon, and who contracts for
such projects with a contractars) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec a" & P.C. for this reason
r
Date/+� -,--17- � a .Owner `'`'( —"""'"-`".
l WORKERS' COMPENSATION DECLARATION
1 hereby affirm that 1 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
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
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 UV 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 Callfomia %
`Date' '< 'owner
NOTICE TO APPLICANT., 9, after making this certificate of Exemption you should become
subject to the Workers' compensation provisions of the Labor Code, you must forthwith
comply with spilt provisions of tha permit shalt 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
Lenders Address
This is a building permit when property 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
No. 05202
BUILDING: •TYPE CONST. OCC: GRP.;
A.P. Number Santa Rosa Cove
0
Legal Description
Project Description
Plan A •- TrZet 14495-4
Sq. Ft.
Size 3720
No. No. DW.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
L"=
$288,544
PERMIT
AMOUNT
Plan Chk. Dep'
71..S S"
Plan Chk. Bal.
Const.
834.50
Mech.
59.00
Electrical
1"". 1
Plumbing
127.00
S.M.I.
18 j n
Grading
Driveway Enc.
Infrastructure
5,817.24
TOTAL
1$7.648.30
REMARKS
(infix! 10 !R70
Yl� �.. t4�tf lr tiMItHL. rvi•,+•�ry
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
12130/x:$
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES;.
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL Sp. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. gp, F7. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CARP. SO. FT.
GAS (FINAL)
WALL Sp. FT.
DRINKING FOUNTAIN,
GROUT
URINAL
SO FTa
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET`
COMPRESSOR HP
POLE, TEWPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE __f__'MECH.FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMB G
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. �/
GAS (ROUGH) -2/2
METER LOOP
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 INSP. /�/lf%//moi
MING ZI
FINAL INSP.
ROOFING 1O 27_
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
AR. FIREWALL
IN
MESH
TION/SOUND
FINISH GRADING
FINAL INSPECTION (/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL