05121 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 76-121 Crimsen Drive LA QUINTA, CALIFORNIA 92253
Mailing
Address 777 S. Main St., Suite 106 • _
City Zip Tel.
Orange 1 92686 1 714-647-8056
Address
City Zip I Tel.
State Lic. City
& Classif. 311261 Lic. # 1177
Arch., Engr.,
Designer
Address Tel.
City( Zip ( State I
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 _
SIGNATURE'S - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bssness and Professions Code: Any ,cify or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the appicant 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 or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenalty of not more than Ove hundred dollars ($500).
❑ 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 appy 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
orimprovements sold within one year or completion, the owner -budder will have the burden
of proving that he did not build or inprove for the Purpose of 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 appy to an owner of property who builds -or improves thereon, and who contracts for
such projects with a contractors) 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 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 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 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: h, after malting this Certificate or Exemption you should become
subject to the workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this 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, Ciel! Code.)
Lenders Name
Lenders Address
This is a building permit when properly 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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 613--790-009
Legal Description
Project Description Building 32, Plan 2L, Lot 306
Sq. Ft. 912 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$65 22 53
PERMIT AMOUNT
Plan Chk. Dep.
Pian Chk. Bal. A 275.61
Const. 331.66
Mech. - '36.00
Electrical 44.7f;
Plumbing 7 . (iii
S.M.I. 54
Grading
Driveway Enc.
Infrastructure 1.467.57
TOTAL 1$;2.272.71 i 1 i t
REMARKS
X ti V. -try. -Y .i, t Yl 1 Ytf. Y
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 DATEINSPECTIOR
Issued by: Date 12/28 ` Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO, PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
7UNDERGROUND
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
SLAB GRADE ( �
ROUGH PLUMB.
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ, Ff.
SEWER OR SEPTIC TA K
ROUGH WIRING
GAR. SQ. FT. 0
POWER OUTLET
ROOF DRAINS
GAS (ROUGH)
METER LOOP
DRAINAGE PIPING
CAR P. I SO. FT. ®
REINF. STEEL
GAS (FINAL)
WALL SQ. FT. ®
DRINKING FOUNTAIN_
SQ FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
FINAL INSP. �D
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
/
SQ.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEEPLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
A.C. UNIT •
COLL. AREA
7UNDERGROUND
SLAB GRADE ( �
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TA K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. ( ?
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
LUMBER GR.
FINAL INSP.
cu. yd.
FRAMING
FINAL INSP. �D
$ plus x$
=$
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
/
SPARK ARRESTOR
GAR. FIREWALLS b
LATHING
MESH
INSULATION/SOUND
-
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FFNr:F FINAI
SIGNATURESIINITIALS
GARDEN WALL FINAL