06370 (SFD)4
P.O. BOX 1504
Building ��} {�iI'}°._'�� 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner ,
Mailing
Address 75-005 Country Club ,
City
i'� Zip Tel.
M Desert 92260
568-2828 _
Contractor
Address
City
State Lic.130 (City
& Classif. Lic. # 328
Arch., Engr.,
Designer
Address Tel.
ityIZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hefeby affirm that I am licensed under provisions of Chapter 9•(commencing with Section
000)t f Division 3 of the Business andProfessions Code, and my licenseISin full force and
OWNER -BUILDER DECLARATION f .
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
permit to construct, after, 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 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 penalty of not more than rove 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. ?044, Buisness and
Professions Code: The Contractors License Law does not apply to an owner of property who
builds or xnmovas thereon and who does such work himself or through Ins own employees,
provided that such inprovernents are not intended or offered for sale. If, however, the building
or improvement is said within one year of completion, the owner -builder will have the burden
of proving that he did not build or inprove 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 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
Thereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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 N 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
Date Owner
NOTICE TO APPLICANT: f1, after making this Certificate of Exemption youshould 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 -
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certity 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.
No. 06370
BUILDING: TYPE CONST. OCC: GRP._
A:P. Number, • - PQ wen y Phase 21A
Legal Description
Project Description Tact 20717-3A Plan 1C'
Sq.'Ft. 13 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuation
PERMIT'
t
BY:
AMOUNT
Plan Chk. Dep.
1
Plan Chk. Bal.
500,41
Const.
Side Setback from Property Line
617..00
Mech.
INSPECTOR
51.00
Electrical
Issued by:
.$9.99
Plumbing
96.00 .
S.M.I.
6.65
Grading
Driveway Enc.
Infrastructure
$2,1.20.49
1,060.25
ax0redit
1,060.25
TOTAL
REMARKS
kiaui.G2' i 11
t?r's? f9 -•"'-J._ .#L)
a:U fi�ftJ#
int"L 1 41.4:1 , iV
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
9/20199
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
N
GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. Fr.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
UND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
I
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CARP. SO. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SO FT ®
GRADING
cu. yd.
-Plus-X$-=$
ESTIMATED CONSTRUCTION VALUATION $
NAL INSPI,,*
WATER PIPING
NOTE: Not to be used as property tax valuation
01 ,�/REMARKS:
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
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 ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACKOUND
PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR S A
ROUGH WIRING
DUCT WORK
ROCK STORAGE
UND. REINF.
AS (ROU�G
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
-Plus-X$-=$
LUMBER GR.
NAL INSPI,,*
FRAMING G'r J
FINAL INSP.
01 ,�/REMARKS:
W
)! H/CJ
ik-
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
(f &ULATION/SOUNDl�,Zy
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
t