06178 (SFD)"tee � "� •.
P.O. BOX 1504 No.' 06178
Addrress 78P950 Skyward Waj 4 LA<OUINTA, CAL FORNIA 92253
Owner
Starlight T2s Parltm
Mailing
Address P. 0. Box '329
City La QuInt4s. [_ Zip .9d253
Contractor
RUT', .30hWW12 Construction
Address .
Sam
I
rehip BUILDING: -TYPE CONST. - - OCC: GRP.-
A.P. Number Tract 23773
el.. 1*�$(.$ Legal Description
Project Description ' 3bde3 AB Apollo-
State
pollo
Tel.:
State Lic.
City
& Classif. 39-716939-7169
I
Arch :, Engr.,
Designer.
Address
Tel.
Lic. # i Sq. Ft. 2687
Size
City (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7fXl(I) of Division 3 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,Bustness 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 rile a signed statement that he is licensed pursuant to
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 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 rive hundred dollars ($500). j
❑ 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
builds or, knproves thereon and who does such work himself or through his own employees,
provided that such Improvements are not intended or offered for safe. If, however, the building
or improvement is sold within one year of completion, the owner-buflder will have the burden
of pr
roving that he did not build or knprove 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. 1i. 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 completed 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
NOTICE TO APPLICANT: ff, 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 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
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 -sof this city .to' enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City,. State, Zip
No.
Stn
� - No. Dw.
• Units-
New ❑ Add' ❑ Alter ❑ Repair ❑
Estimated Valuation •-
t
PERMIT AMOUNT
Plan Chk. Dep.-
Plan Chk. Bal. - - $ • 652.19 '
• Const.','-_ - 786.50 .
Mech. 66. 50
Electrical 142.33 ••
Plumbing 150o30 V ,
S.M.I. 9.$4 '
Grading -
Driveway Enc.
Infrastructure 3,172,931`-=
TOTAL S`4»980a91 iY_'I, "/7
Demolitiari ❑
REMARKS • r...n.:'.sshha•'s/L :�AtB.r aart:.��_r;�'.='e.x'!
t.��.r..�:`�f�ti`:t"'t#'i'Sti�w�.. v �d�•�ik.�,'r.-:a :.
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 - I/NfSPECpT�OR - -
Issued by: • Date - Permit
.
•Validated
by:
'
Validation:
•• • - -
by:
'
Validation:
•• • - -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
OUGH PLUMB. BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING,
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
AS (ROUGH)qfi l '1 METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GROUT
DRAINAGE PIPING
CAR P. SO. FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL. SO. FT.
-$
LUMBER GR.
FINAL INSP. s' Old L
FRAMI� 90j �a
URINAL
SOFT ®
\ /p� Q `
ESTIMATED CONSTRUCTION VALUATION $
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
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ec
HOUSE SEWER
FENCE FINAL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEEPL.CK.FEE
CONST. FEESMI
rECT.
FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GOUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
OUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF. �v �J
AS (ROUGH)qfi l '1 METER LOOP
HEATING (FINAL)
OTHER APPJEGUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
-$
LUMBER GR.
FINAL INSP. s' Old L
FRAMI� 90j �a
FINAL INSP. 3ls/��u
ROOFING Ams
IZ C°l �
\ /p� Q `
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR .
GAR. FIREWALL
LATHING I%I�
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION 3 [ SG Gll
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS _
GARDEN WALL FINAL