003893 (AR)•
P.O. BOX 1504
Building78-105 CALLE ESTADO
Address 78-435 � Crestview Te: raGFLA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address same
City Zip Tel.
La 0ainta - 32253 _
Contractor
No. 003893
BUILDING: TYPE CONST. OCC. GRP.
A.P.-Number 517-063--015
Legal Description
Project Description ROOM. Addition
or less:)
1 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. 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 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
HARD COPY
City
Zip
Tel _
Minimum Setback
_
Distances i1 f'A T t=-00226,-ff '
State Lic.
& Classif.
City
Lic. #
Sq. Ft.
Size - - 37
No. No. Dw.
Stories Units
Arch., Engr., - -
.Designer
New ❑ - Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
FINAL DATE
INSPECTOR
Issued by:
Date 4/26/8$Permit
City
. .
Zip
-
State
Lic. # -
Validation:
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 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, atter, 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 civil penalty of not more than five hundred dollars ($500).
y, or my employees with wages as their sole compensation, will
ki: as owner of the property,
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,
I provided that such 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 'hat he did not build or improve for the purpose of sale.)
❑ I, 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 _-
I does not apply 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
r j
Estimated Valuation
$1-1,353
PERMIT
_ ••
•• AMOUNT
Plan Chk. Dep. -
-`
Plan Chk. Bal.
c .y r
n O e *52
S
Const.
i128.501
- Mech.
'
-
Electrical
- � ,, t�tj
Plumbing
S.M.I.
- .1 23
Grading
Driveway Enc.
f/
Date �'�f 'b Owner r' �� 'j 4.1"tA' 1 �.. r�• Iii • .,-t
Infrastructure
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
❑ Copy is filed with the city. O 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 ($100) valuation
TOTAL
'
REMARKS
or less:)
1 certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.
Date—'—Owner '
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions.of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is _issued. (Sec. 3097, Civil Code.) -
Lender's Name
Lender's Address
This is a building permit when properly filled' out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
ZONE:
BY' -
Minimum Setback
_
Distances i1 f'A T t=-00226,-ff '
Front Setback from Center Line.
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 4/26/8$Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES'
IST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. S0. FT.
BONDING
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL S0. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
WATER SYSTEM
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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+/a c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FIREPLACE
GAS PIPING
PERMIT FEE
SPARK ARRESTOR
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
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)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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.
�RAMING S �/�
FINAL INSP.
ROOFING
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL 7d
DESERT SANDS UNIFIED SCHOOL DISTRICT
NOTICE: THIS DOCUi�fiEN r deo 922011
BE DUPLICATED.
CERTIFICATE OF SCHOOL FACILITY FEE WAIVER
IN ffR1Q
A
i
DATE: Wd9 D
This is to cArtify tha — ,
developer of , whh is
located at 36 - within
this school district, is not required to pay school facility fe
pursuant to the authority generated by Government Code Section 53080.
Building permits for the project indicated above may nowbeissued by your
juri:sdiction_. IF VALUATION INDICATED 0 BUILDING PERMIT EXCEEDS $20,000;
THIS WAIVER IS VOID AND A SCcI00L FACT TES FEE MUST BE PAID PRIOR T J
ISSUANCE OF BUILDING PERMIT.
or*OESERT SANDS UN"IFIE0 SCHOOL DISTRICT
White -Building Department Yellow -Facilities Planning Pink -Developer (10)-38