04473 (SATT).D47473
t
City (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1am 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
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
Estimated Valuation
$120016,9 ppy
permit to construct, alter; 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
PERMIT
P.O. BOX 1504
-_
Building
Address
!;_1,!;9t � � �%
78-105 CALLE ESTADO
LA.QUINTA, CALIFORNIA 92253
Plan Chk. Dep.
•
the alleged exemption. violation of applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
Owner .
.
' do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
k .:-Sunrise
Co'
Professions Code: The Contractor's License Law does not apply to an owner of property who
.
Mailing
builds or improves thereon and who does such work himself or through his own employees,
BUILDING: 'TYPE CONST.
OCC. GRP. ' •_ •- "
Address -
7S-005 ='dry �`lUb Dr, W6 , .'. A.P.•Nufnber _ P Webb °�
; r
Tits dX'c'3- nIt
City
Zip
Tel.
or proving that he did not build or improve for the purpose of sale.)
Pala Deseit 92260
,.
Legal Description
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
.Contractor
105 a 00
Project Description Phase 41r,
- PlAn �
8 0 44
National Mortqaqe
Grading
-
Address
Driveway Enc.
Sam�.,
Date Owner
Infrastructure
City
Zip
Tel.
s
State Lic.
' & Classif.
288130
City
Lic: #39 3 , ... . , � � .
,Sq. Ft. , 1700 � No.
1 '
No. Dw.•
,
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
. .
Size Stories
Units
Arch., Engr.,
$2A70-37 1V
�
TOTAL
,
Designer
REMARKS
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Address
or less.)
Tel.
_ -
I certify that in the performance of thg work for which this permit is issued, I shall not
City (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1am 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
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
Estimated Valuation
$120016,9 ppy
permit to construct, alter; 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
PERMIT
AMOUNT
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 Any Section 7031.5 by 'any for
Plan Chk. Dep.
the alleged exemption. violation of applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
Pian Chk. BBI.
••Y
,tL • E`,• l
0
❑ 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
COf1St.y
N_`
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,
Mech.
39 * QQ
provided that such improvements are not intended or offered for sale. If, however, the building
orimprovement is sold within one year of completion, the owner -builder will have the burden
Electrical
_72150
6Yr
or proving that he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
105 a 00
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
S.M.I.
8 0 44
such projects with a contracfor(s) licensed pursuant to the Contractor's License Law.) -
Grading
-
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
cc��
0"Z. ! 147w .
WORKERS' COMPENSATION DECLARATION
at XiZtras�o.`,iruc 1 ure I ,�i • Ei Li
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.)
Policy No. Company
$2A70-37 1V
❑Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
:
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE.
(This section -need not be completed if the permit is for one hundred dollars ($100) valuation
_ �4 '
ry+ 4 4. E {ta--sJ',;;rf y, V�(,:i', r" ,` ; 0
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: 8, alter making this Certificate or Exemption you should become
ZONE:
BY:
' subject to the Workers' Compensation provisions of the Labor code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
_
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.)
-
Side Setback from Property Line
Lender's Name
1
Lender's Address,
-FINAL DATE
r
INSPECTOR
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.
/ r,
I certify that I have read this application and state that the above information is correct.
Issued by:
Date Permit --
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City,, State, Zip
• ,r "'
GOLDENROD_ ASSESSOR'S OFFICE HARD COPY = FILE%�
..
WHITE FINANCE; PINK APPLICANT GREEN- BUILDING,
erz �....,, .,. _:v z ., ._ _.. ,. _._ 4 �... .,.-_._ .r:...r.
_,� ,,..,t, ..._..-
s•.,.._ a -tip,. - __ _�t._ �, ... 2... ... .- ._.
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
ISI FL SO Fl rp
UNITS
UNDERGROUND
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
2ND FL SO FT. a
BONDING
HEATING (ROUGH)
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR SO FT er
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR SO. FT. fp
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO FT. 0
GROUT
WATER HEATER
SERVICE
FINAL INSP.
DRINKING FOUNTAIN
WALL SO. FT. Q
WATER SYSTEM
GRADING
cu. y0.
$ plus x$
-$
URINAL
SO. FT. (d
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION S
WATER PIPING
NOTE: Not to be used as property tax valuation
'
FLOOR DRAIN
MECHANICAL FEES
IWATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SO. FT.'® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g 11/. c
SEWAGE DISPOSAL
SO.FT.GAR (a 3:c
HOUSE SEWER
�7
N
cam'
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 PLUMBIArG ELECTRICAL HEATING 8 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./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. y0.
$ plus x$
-$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
�7
N
cam'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL