04181 (GRES)r
Building
Address
Owner
Mailing
''Address
_EIy
Co
Address
City ' , Zip
State Lic.
& Classif. 462814-
Arch.,
628 .4Arch., Engr.,
Designer
ry P.O. BOX 1504
1 y 78-105 CALLE ESTADO
78"-35-p 1"ar . a Cotta Ct. LA QUINTA, CALIFORNIA 92253 F
777 S. Main St# Suite 106
Zip Tel.
fnge 119,2686 714«-547-00
Address
Tel.
BUILDING: TYPE CONST. r OCC. GRP. ,
A.P.-Number 613-790-001
Legal Description
Project Description Baildincr 10, Plan 2
Vlty .
Lic. # r, r t.Sq- Ft.
ze
City Zip State
Lic. #
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 Professlons' Code, and my license is in full force and
effect.rf
SIGNATURE c - -- "' 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, 'alter, 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
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 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 ownerof 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.)
❑ 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. & 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 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.
Date Owner
M 9'12 No.
. Stories
New ❑ Add ❑ Alter ❑
No. Dw.
Units
Repair ❑ Demolition O
PERMIT
dAMOUNT '
Plan Chk. Dep.
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith -
' comply with such provisions or this permit shall be deemed revoked.
Plan Chk. Bal.
Const.
Front Setback from Center Line '
Mech.
Electrical
44#1b
Plumbing
Side Street Setback from Center Line
S.M.I.
Grading
work for which this permit is issued. (Sec. 3097, Civil Code.)
Driveway Enc.
Side Setback from Property Line
Infrastructuret
6 / -37
G X'.RiIb�E3""it.'t7�3CJt
lLs�,�E�GGi,..f' r3. �t.�3
FINAL DATE
-INSPECTOR
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.
TOTAL•
Date Permit
REMARKS.<6
71
construction, and hereby authorize representatives -of this city to enter the above-
. NOTICE TO APPLICANT:" If, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith -
' comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: ,
Front Setback from Center Line '
'
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY.
Side Street Setback from Center Line
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 Setback from Property Line
Lender's - Name
Lender's Address
This is a building permit when properfyfilled out, signed and validated, acid is subject to'
FINAL DATE
-INSPECTOR
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.
Issued by:
Date Permit
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.
Validated by:. '
,Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
WHITE - FINANCE, PINK APPLICANT, GREEN - BUILDING;
GOLDENROD - ASSESSOR'S OFFICE , HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO FT (a S
UNITS
COLL. AREA
SLAB GRADE ! �g
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. gr
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
DUCT WORK
ROCK STORAGE
D. REINFg /--4;�
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Fx
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CARP. SO FT. fa'
GROUT
WATER HEATER
FOUNTAIN
WALL SO. FT. 0DRINKING
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. 0
GRADING
cu. yd.
E plus xi
'
=3
ESTIMATED CONSTRUCTION VALUATION $
FINALINSP. �7j
v
WATER PIPING
NOTE: Not to be used as property tax valuation
6OFING[ S
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
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,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
M SH
r
SO, FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 11/4 c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GARrg Vc
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 ^ /f ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBIN' /
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ! �g
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
D. REINFg /--4;�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
E plus xi
'
=3
LUMBER GR.
FINALINSP. �7j
v
"MINGZ— �%
FINAL INSP.
6OFING[ S
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
. FIR WALL2lZ1--/
LATHING
-
M SH
r
ULATIONISOUN
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATU iESIINITIALS
GARDEN WALL FINAL