04894 (SFD),• 048$4
r , P.O. BOX 1504
Building 18-105 CALLE ESTADO
Address 49v-095 TanSo Couri - LA QUINTA, CALIFORNIA 92253,
Owner . A
'
BUILDING: TYPE'CONST. OCC. GRP.
Mailing
.Address- 68•:7.15 lareaa Road .#& -' A.P. Number Pare La Qulitt>Ga
City Zip Tel.
cAr> hed . aid.• to 422 36 '7'f $-9.02 i
Legal Description a
Contractor . - Project Description -
State
2222. phos- a - .� � Liar 6
1
State Lic.
& Classif. !�
Arch., Engr.,
Designer
Address
;y
Tel.
City
Lic. # 1 Sq. Ft. 2222 No.., No. Dw.
' Size Stories Units
Tel.
New ❑ Add ❑ Alter ❑ Repair ❑ . Demolition ❑
City
Zip
State
Lic. #
i • LICENSED CONTRACTOR'S DECLARATION
"
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) 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
Estimated Valuation
j $ `
reason: (Sec.- 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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 Contractor's License Law, Chapter 9 (commencing with Section 7000) of
PERMIT AMOUNT
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 five hundred dollars ($500).
O 1, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Dep. $2.50's 00 '
,
Plan Chk. Bal. 1 3 % 1; 64
l'ipnSt.5, +,
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 o/ property who
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Mech. -fa ♦"N
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
Electric°al`'' `Z)- •' ��'• I .19
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 o/ sale.)
Plumbing-� .:00struct
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not applyto an owner of property who builds or improves thereon• and who contracts for
such projects with a oontractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. & P.C. for this reason
S.M.I. i .88
_ .
Grading
Driveway Enc.
Date owner
QY
InfraStrUClUfe 2.0523.61.
WORKERS' COMPENSATION DECLARATION l
1
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.
t
TOTAL .a a nr . w 4v C', Zi
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit Is for one hundred dollars ($100) valuation
or less.) w
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation '
Laws of California. ••
REMARKS
.cr •t�
' ,1>fa`,�..r 7l�;p?� e�� +`P't.t=•;�'�-�F:FiIi4 e af'4' ?ted
-
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
' subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
• comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances: -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line l
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
- d
Side Setback from Property Line -
Lender's Name
• Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
• expiration, if work thereunder is suspended for 180 days.,
' I certify that I have read this application and state that the above information Is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives .of this city to enter the above-
mentioned property, for inspection purposes. ,
- Signature of applicant Date
- {-• _
FINAL DATE IJN50EC OR•
Issued by: Date Permit
Validated by:
,
Mailing Address
Validation: -
-
_ _+
City, State; Zip •
GOLDENROD -ASSESSOR'S OFFICE, HARD COPY -FILE i'
y_ •'" _ WHITE FINANCE, PINK - APPLICANT, GREEN BUILDING,'
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FIL SO FT 47 t
UNITS
RADE —/$��
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND Fl SO FT. a
FO MS
ER OR cXIC
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT at
/
GAS (ROUGH) V
R LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. fpr
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO FT. ra
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. 0
=$
LUMBER GR.
FINAL INSP. '� ��
URINAL
SO. FT. 0
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
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,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. a c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a I'A c
SEWAGE DISPOSAL
SO.FT.GAR @ ;4c
HOUSE SEWER
'
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE bL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
D PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
RADE —/$��
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FO MS
ER OR cXIC
ROUGH WIRING
DUCT WORK
ROCK STORAGE
D. REINF/ —,/'j:T—S
/
/
GAS (ROUGH) V
R LOOP
HEATING (FINAL)
OTHER APP.IEOUIF.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. ytl.
y plus x3
=$
LUMBER GR.
FINAL INSP. '� ��
FRAMING
FINAL INSP. %
ROOFING
@
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL