04911 (SFD)t4 4Q"
P.O. BOX 1504
Building. ��� '7`&it Court ` 78-105 CALLE ESTADO.
Address , LA QUINTA, CALIFORNIA 92253
BalrCon Dave lopment
Mailing
Address 68_713 Perez Road
CityZip Tel.
Cathedral Cita 92234 773-9024.
Contractor
Same
BUILDING: TYPE CONST
No.
OCC: GRP.
Number Fa1~'C La Qointa
0491.
Legal Description
Projec t D escription plan. 2017 Lot .$
City, State, Zip
City
Zip
Tela
State Lic.
City
& Classif. 337077
Lic. # 1219
Sq. Ft. 2017
No. 2 No. Dw.
'Size
Stories' Units"
Arch., Engr.,'
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am,libensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the•Business and Professions Code, and my licgpse:ls in full force and
effect^� / �` - --•--• f c`. J r)'
1.
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
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 penafly of not more than five hundred dollars (5500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation
i 02.02.6
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
y 368..85
Const.
440.50
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Busyness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
Mech.
42.00
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. f. however, the building
or improvement is sold within one year of compfetfon, the owner -budder will have the burden
of proving that he did not build or improve 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.)
❑ I am exempt under Sec B. 8 P.C. for this reason
Electrical
7Q. _
Plumbing
94..00
S.M.I.
7. It
Grading
Driveway Enc.
Date Owner s,..
Infrastructure
2,+235.59
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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
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
TOTAL
$3,327.C.2
REMARKS
}}
N ; ,' } 05 4Ar-, �; lJT-5"'17
s, 1 " P
Date Owner
NOTICE TO APPLICANT., ff, 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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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.)
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE
INSPEC OR
12, /88
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.
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.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
_
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. Sp, Ff. ®
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEDUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. Sp. FT. @
WALL SO. FT.
DRINKING FOUNTAIN.
SERVICE
FINAL INSP.
URINAL
Sp FT ®
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
plus x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
ROOFING �
VENTILATION
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,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% c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
T
TOTAL FEES
MICRO FEE
I I
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEEI I I
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
D PLUMBW
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUG PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH) 7/?j l
ER LOOP
HEATING (FINAL)
OTHER APPJEDUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FRAMINGqhl"Ar
FINAL INSP.
ROOFING �
VENTILATION
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�1
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REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING (w dGZr
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t