06424 (SFD)P.O. BOX 1504
Building54-672Shoal Creek 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
mise co1ftpany
Mailing
Address 42-600 Cook Sty #200
City Zip Tel.
Contractor
City IZip ITel.* ,
State Lic. City
& Classif. 288130 Lic. # 328. _
Arch.; Engr.,
Designer
Address Tel.
City Zip State
Lic. #
/ LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70D,0) of Division 3 of the Business and Professions Code, and my license is in full force and
Vect. ) 7t r -a: Y J. f.' .1 ; ...,., t . / f� .'i ce! /t! t.;
SIGNATURE ! f u.J J' DATE
I OWNER -BUILDER DECLARATION ' d
Ifhereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Bushess and Professions Code: Any city or county which requires a
Permit to, construct, after, irprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such Permit to fife 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 or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a ciw penally of not more than two hundred dollars (8500).
❑ 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 who
bulks 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 Whin one year of completion, the owner -builder will have the burden
of proving that he did not build orirprove 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 (hereon, and who contracts for
such projects with a cordrauxor(s) licensed pursuant to the Contractors License Law.)
❑ 1 am exempt under Sec B, g, 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
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 if the pemuft Is for one hundred dollars (8100) 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. d, after making this CertiTcete of Exemption 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.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued- (Sec. 3097, Civil Code.)
Lenders 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 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'
No. 06424
BUILDING: -TYPE CONST: OCC: GRP.
A.P.. Number PCA Fest W Phase 1$A
Legal Description
Project Description Traet 20717-3. PlA t 2M
REMARKS
I #L t!T,i#'af'f`'1''.t€Iii:`"# • x iiYY r e
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
Issued by: Date 9128189 Permit
Validated by:
Validation: `.
Sq. Ft. 154E
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$10804.5
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
.S 711
Const.
.00
Mech.
51.U0
Electrical
98.1.6 ,
Plumbing
1.314,0
S.M.I.
19.63
Grading
Driveway Enc.
Infrastructure
s�2si .x
a •
Lena (Xedlt
1,ZZ1. 14
TOTAL
Yl a +':9 •
�} %F y /t.
REMARKS
I #L t!T,i#'af'f`'1''.t€Iii:`"# • x iiYY r e
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
Issued by: Date 9128189 Permit
Validated by:
Validation: `.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
B GRADE r
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
ER OR SEPf
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
AS(ROUGH)
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. ®
=$
LUMBER GR.
%NAL INSP.,`?i�'-qa
RAMING
v
URINAL
SD. FT.
yt Z
I
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n rJ
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ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
WATER PIPING
NOTE: Not to be used as property tax valuation
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
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
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
FINISH GRADING
SO. FT. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% 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
SET CK
UND PLUMBING i)UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE r
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SEPf
ROUGH WIRING
DUCT WORK
ROCK STORAGE
F REINF.2
AS(ROUGH)
HEATING (FINAL)
OTHER APPJEOUIP.
INF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
%NAL INSP.,`?i�'-qa
RAMING
v
FINAL INSP.
OOFING l y
yt Z
I
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n rJ
r —�J �� �r
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
CATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL