04899 (SFD)'_ ,: • state Lic. q ry
?' & Classif.
�t
t Arch., Engr.,
Designer
- Address
Zip ITel. .
City2222
Lic. # Sq. Ft.
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 Division3 of the Business and Professions Code, and my license is in full force and
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, alter, Improve, demolish, or repair any structure, prior to its issuance also
No.* - - No. Dw.
Stories Units
New O Add O Alter ❑ Repair ❑ Demolition O
Itstimatea valuation $1 I 161
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 ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who4
builds or Improves thereon and who does such work•himself or through his own employees,
provided that such Improvements are not intended or offered for sale. If, however, the building•
or Improvement is.•sold within one year of completion, the owner -builder will have the burden\
of proving that he did not build or improve for the purpose of sale.)
PERMIT
AMOUNT
Plan Chk. Dep.
•
Plan Chk. Bal.
,
Const.
+si y7. , I�'•-
Mech.
- '�•-'
EleCtrlCa� ' , •;;• •
- -
-AA �14
Plumbing
9A. nO
❑ 1, as owner of the property; am exclusively contracting with licensed contractors to con:
struct the project. � (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
S.M,I•
w '.
-
Grading
-• P.O. BOX 1504
Buildingr
Address
49-040
Serenity tu®�tv1 '
' s 78-105 CALLE ESTADO
•L'A QUINTA,.CALIFORNIA 92253
Owner
• WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
' 4
SAACON
09VELOPME1 '
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
Mailing
TOTAL
I r*? :.Iram Adz I to
BUILDING: TYPE CONST. OCC. GRP.
-
Address
08-713
Perez R41014d`01Pa
`• R1�xfi�ti,'1i i:�? {L'r$'''[.•�Q3}...P+F'�,?, �j,; �s
re La Quinta
-
, " •
A.P. Number
City
ra ��
Zip
9223
Tel.
y „ ,.Q.,
- Front Setback from Center Line
Rear Setback from Rear Prop' Line
r
Legal, Description
,ContractorProject
Side Street Setback from Center Line
- 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.)
- Plan 22.21# Phetle I'
Description
'
Same
• Lender's •Address
This is a building' permit when properly filled out, signed and validated, and is subject to ,
expiration it work thereunder is suspended for 180 days.
e. I certify that I have read this application and state that the above information is correct.
f 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 pioperty for inspection purposes.
Address
INSPECTOR
} �'
Date - Permit
~Signature of applicant Date -
kt " -
Lot 22
+'Mailing Address -
'_ ,: • state Lic. q ry
?' & Classif.
�t
t Arch., Engr.,
Designer
- Address
Zip ITel. .
City2222
Lic. # Sq. Ft.
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 Division3 of the Business and Professions Code, and my license is in full force and
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, alter, Improve, demolish, or repair any structure, prior to its issuance also
No.* - - No. Dw.
Stories Units
New O Add O Alter ❑ Repair ❑ Demolition O
Itstimatea valuation $1 I 161
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 ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who4
builds or Improves thereon and who does such work•himself or through his own employees,
provided that such Improvements are not intended or offered for sale. If, however, the building•
or Improvement is.•sold within one year of completion, the owner -builder will have the burden\
of proving that he did not build or improve for the purpose of sale.)
PERMIT
AMOUNT
Plan Chk. Dep.
•
Plan Chk. Bal.
,
Const.
+si y7. , I�'•-
Mech.
- '�•-'
EleCtrlCa� ' , •;;• •
- -
-AA �14
Plumbing
9A. nO
❑ 1, as owner of the property; am exclusively contracting with licensed contractors to con:
struct the project. � (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
S.M,I•
w '.
-
Grading
_-
,.
Driveway Enc.
Date Owner
Infrastructure
2.5 21 (h l'
• WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
' 4
_
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
N ,� '
TOTAL
I r*? :.Iram Adz I to
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
`• R1�xfi�ti,'1i i:�? {L'r$'''[.•�Q3}...P+F'�,?, �j,; �s
(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 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.
-
1
Date Owner
t ' NOTICE TO APPLICANT: If, after makingthis Certificate of Exemption
D 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. -
+
ZONE: - BY:
Minimum Setback Distances: - -
•
- Front Setback from Center Line
Rear Setback from Rear Prop' Line
• __
^` CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
- 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.)
r..
Side Setback from Property Line
Lender's Name
• Lender's •Address
This is a building' permit when properly filled out, signed and validated, and is subject to ,
expiration it work thereunder is suspended for 180 days.
e. I certify that I have read this application and state that the above information is correct.
f 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 pioperty for inspection purposes.
'FINAL DATE
Issued by:
-
Validated bye
INSPECTOR
} �'
Date - Permit
~Signature of applicant Date -
'
'
+'Mailing Address -
,Validation.•
GOLDENROD -ASSESSOR'S OFFICE, HARD -COPY- FILE
:"`5 t1.1- "1•. , .a -, t, -T �.i'.:. • •c ..aa _ .,tx...�.•. �t • l ,.5. ��Y t: !4s_ ✓ �.4 . ...
r. City, .State, ,Zip s.
- i WHITE FINANCE; PINK APPLICANT,, GREEN BUILDING,
•} :--. - -:'i .. - FS, l_ � • • 1 t �-�•.:1�..Sti •...i .:. '.� y. ..�.-�: . rte. `F•i+_`f
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL, SO FT !P $
UNITS
ROUGH PLUMB BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SO FT. Q
DUCT WORK
ROCK STORAGE
e—UND. REINF.% ��
MOBILEHOME SVC.
BAR SINK
POR SO FT. at
REINF. STEEL
GAS (FINAL) -a '� MP. POLE
GAS
V
I 1POWER OUTLET
ROOF DRAINS
GAR SO. FT.
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRAINAGE PIPING
CAR P. SO FT. r
LUMBER GR.
FINAL INSP 3
FRAMING S �Z/�
FINAL INSP.�-
DRINKING FOUNTAIN
WALL SO. FT. a
REMARKS:
URINAL
SO. FT. fa
FIRE ZONE ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
-
FLOOR DRAIN
MECHANICAL FEES
SPARK ARRESTOR -
IWATERSOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH),,
APPLIANCE DRYER
LATHING
GARBAGE DISPOSAL
FURNACE .UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g tv: c
SEWAGE DISPOSAL
SO.FT.GAR i& Y c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE y PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
ROUND PLUMBING 4 UNDERGROUND
A.C. UNIT
COLL. AREA
GRADEZ
ROUGH PLUMB BONDING
HEATING (ROUGH)
STORAGE TANK
FO MS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
e—UND. REINF.% ��
GAS (ROUGH) ( TER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL) -a '� MP. POLE
GAS
V
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP 3
FRAMING S �Z/�
FINAL INSP.�-
ROOFING
D
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL