05727 (SFD)4
` ..; P.O. BOX 1504N O. 05727
Building 32-165 JMEZ 78-105 CALLE ESTADO
Address - • •LA QUINTA, CALIFORNIA 92253
Owner _
BUILDING: TYPE CONST. OCC: GRP.
Address
Mailing 247 R. TARQMZ WAY #2 `„
.. , . _ .A.P
. Number
City f?Ai SP3�it`tGS Zip 92262 Tb3/322—i42? 8 t#NZ'i I
Legal Description
SUM CONSTRUCTION -
Address.,
State Lic. City
& Classif. 387934 1 Lic. # 895
r11 VI1., Gl lyl., 'S
Designer
Address I 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 Div�is,i�o:n,3 of the �BBusfiiness and Professions Code, and my license is in full forcel�anld+
effect. •r•�"x'''f" I— 4Y/ �d/�. �:: c_ c�....� ..5-Z,07 �yy
SIGNATURE t r / DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiress and Professions Gide: Any city or county which requires a
permit to construct, after, irprove, demofth, or repair any structure, prior to its issuance also
requires the applicant for such pemtft to Me 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 viobtion of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a c" 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, Suisness and
Professions Code: The Contractors 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. If, however, the building
or Improvement is sold within one year of compilation, the owner -builder will have the burden
of proving that. he did not bu8d orrrprove for the purpose of sale-)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the projects (Sec- 7044, Business and Professions Code: The Contractor's License Law
does not apply to 'an owner of property who builds or bnproves 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
WorkePs Compensation Insurance, or a certified copy t ereof ,(Sec. 3800, Labor Code.)
Policy No. Company • � � C`. �,.e!'z? -
❑ Copy is filed with 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 (S 100) valuation
or less-)
I certify that in the performance of thg 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: ft, 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 pemx7 shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec- 3097, Cin? Code-)
Lenders 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 appliption 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
roject Description
Sq. Ft. 1409 No.1 No. Dw.
Size • Stories Units
New 9 Add ❑ Alter ❑ Repair ❑ Demolition ❑
Lstlmatea valuation
$76,360.00 i
PERMIT
1
AMOUNT
Plan Chk. Dep..
250.00
Plan ChK Bal.
212..59
Const.
536.00
Mech.
53.50
Electrical
106.41
Plumbing
157.50
S.M.I.
5.39
Grading
20.00
Driveway Enc.
20.00
Infrastructure
s '`
t
TOTAL
REMARKS
r+:r�rs-e .g rt :-v�..r..';�zi_.t�s_ts«"an: nn t,i
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 INSPECTQSR- f
Issued by: Date / Permit
i
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
VALAB GRADE
ROUGH PLUMB.` BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH) METER LOOP
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL) TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER SERVICE
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING �. /
FLOOR DRAIN
MECHANICAL FEES
•
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�T
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET`
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 34c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE IF L.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK -�j
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
VALAB GRADE
ROUGH PLUMB.` BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (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.
ROOFINC,wG/e-
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND�
FINISH GRADING
INAL INSPECTION/6-0,507_
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL 7d