04913 (SFD)Building
Address
Owner
Mailing
Address
City
T4'tiq� 4 4 Q"
P.O. BOX 1504
78-105 CALLE ESTADO
49-'370 ` ane -0 Court LA QUINTA, CALIFORNIA 92253
BsrCon Develoviment
Contractor
Q
Address
City
No.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PArr LA niairrtm
Tel.
"-7y,, A1,,,, [Legal Description
State Lica
City
&Classif.337077
Lic.# 1219
I
Arch., Engr.,
Designer
Address
Tel.
City
Zip
State fi
79.50
Plumbing
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. r ) �sr �• ,� �+.�, � �. �, yI,
,r. s
.SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affign that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busfness and Professions Code: Any city or county which requires a
permit to construct, after, mprove, 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 Contractors 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 penally of not more than rive 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, Buisness and
Professions Code: The Contractors License Law does not apply to an owner of property who
builds or bmproves thereon acrd 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 krtprove 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
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
Date • Owner i A
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. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed ff the permit is for one hundred dollars (5100) 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.
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 thfs 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
04933
Description Sal an 2017 — Lot- 19
Sq. Ft. 2017 No. 2 No. Dw.
Size Stories Units -
I New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
369.85
Const.
440.50
Mech.
44.00
Electrical
79.50
Plumbing
94.00
S.M.I.
7.18
Grading
Driveway Enc.
Infrastructure
2,295.59
TOTAL
$3.317.61 _J
REMARKS W _
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
2�
8
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL AREA
SLAB GRADE �� '
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. $p, FT. ®
ROUGH WIRING
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
GAS (ROUGH) -7 /e//�
G
R LOOP
HEATING (FINAL)
DRAINAGE PIPING
CARP. SQ. FT.
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN.
WALL SQ. FT.
GROUT
WATER HEATER
SERVICE
URINAL
SO. FT.
BOND BEAM
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE Not to be used as property tax valuation
�ING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
^ �
✓
t
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
INSULATIONISOUND 7
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
ME:;H.FEE PL.CK.FEECONST.
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 �� '
ROUG PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS ' ��
ER O
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) -7 /e//�
G
R LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
�ING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. 6
FRAMING Z�
FINAL INSP.
ROOFING 3 -
^ �
✓
t
REMARKS:
VENTILATION
FIRE ZONE ROOFING :
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
.��7 p�
LATHING
MESH
INSULATIONISOUND 7
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESaNITIALS
GARDEN WALL FINAL