06378 (SFD)Building 54-443 SWal Creek
Address
Owner
Address
City
Contractor
ress
Smriee Corspany
Zip
City lZip Tel:
P.O. BOX 1504
713105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
1
State Lic. City
& Classif. 288.130 Lic. # 3128
Arch., Engr.,
Designer
AddressTel.
City I
Zip I State
Lic. #
fr LICENSED CONTRACTOR'S DECLARATION
I hereby affimm that I am licensed under provisions of Chapter 9 (commencing with Section
ec o
e r Division 3 of the Business and Professions Code, and my license is in full force and
effect a y
SIGNATLRE f' + DATE
(' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usi ess 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 pemo7 to Me 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 P otessions 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 riot 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 Con bac:Ws 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,
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.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct
onstruct 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
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' COMPENSATION INSURANCE
(This section need not be corrpleted 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-
Date-owner
aliforniaDateOwner
NOTICE TO APPLICANT: lt, after mafahg 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 Ills 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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 160 days.
1 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
'ZO 4,_1
Na (16378
BUILDING: TYPE CONST. OCC: GRP.
A.P.,Number PCA Hest — Phase 21A
Legal Description
Project Description iritet 207717--3. Plrm AM
Infrastructure
U P556.8f 1,279.43
Leesa Credit
1,279.43
Sq. Ft. 16,27 No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
TOTAL
$2.822.09
REMARKS
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Estimated Valuation $113,727
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
S81 06
Const.
688.50
Mech.o
.
Electrical101-12
Plumbing
131.M
S.M.I.
7.99
Grading
Driveway Enc.
Infrastructure
U P556.8f 1,279.43
Leesa Credit
1,279.43
TOTAL
$2.822.09
REMARKS
ter,« -.aeon ssf� ra�rsP,nn-�v',a.-7eJ zl
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 p INSPECTOR
Issued by: Datt9120189 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. ® s
UNITS
�7
RADE / r '
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
2ND FIL SO. FT.
FORMS
r
ER OR SE A / ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SD. FT. ®
(ROUGH /v METER LOOP
HEATING (FINAL)
OUTLET
ROOF DRAINS
GAR. SO. FT. @POWER
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. ®
LUMBER GR.
�//,�
(.4mAL INSP ; .�V
AIERAMING
URINAL
SO. FT. @
^ G✓ /
/YL/) /V �i V/�
ESTIMATED CONSTRUCTION VALUATION E
WATER PIPING
NOTE: Not to be used as property tax valuation
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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 ® 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
FENCE FINAL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE tL.CK.FEE 7ONST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SET CK
ROUND PLUMBING /J r%/ UNDERGROUND
A.C. UNIT
COLL. AREA
�7
RADE / r '
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
r
ER OR SE A / ROUGH WIRING
DUCT WORK
ROCK STORAGE
F ND. REINF.1/4AS
(ROUGH /v METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
1 EINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
y
GRADING
cu. yd.
-Plus-X$-=$
LUMBER GR.
�//,�
(.4mAL INSP ; .�V
AIERAMING
FINAL INSP.
dGCOOFINGI _��
^ G✓ /
/YL/) /V �i V/�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
AW_NSULATION1SOUND/?,�-9?e,/_
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
t