06852 (SFD)Building` ,/�p+y�
ArfrlraQeA B—nAl1 �fclL16'�'�1Y►CI.R< i .
owner 4
La QuInta Associates
Mailing
Address43.-875 Wasb1figton St.
City lZip
Pe]a Desert - •92260
Contractor p f� q
.. E. 6. wi l l i f3ms DeV a 4di
Address
P.O. BOX 1504 N O . 06,852
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253•
BUILDING:, TYPE CONST. OCC: GRP. ,.
A.P. Number Tract 22982 — Phase iv
Tel. Cactus F'�awer
345.7541 Legal Description
Project Description Plan = Lot 116
P I Tel.:
State Lic. .—[City
—
& Classif. 493919 Lic- # 1231
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
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
reason: (Sec. 7031.5,13usfiess and Professions Code: Any city or county which requires a
pennft to construct, after, improve, demolish, or repair any structure, phor 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.cMl 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
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 Improves thereon and who does such work himself or through his own employees,
provided Nat' such improvements. are not intended or offered for safe: If, however, the bmTding.
. or Irtprovement . is said within one year •of completion,' the owner-buflder will have the burden --
. .of proving that he did not build. or Inprove for the purpose of sale.) , - l
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractors 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.1& P C. for this reason ✓`Z .
Date) "t Owner�t�t .:' �✓'�, r=.•�S 4- �r'� • l 7
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora 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.)
1 certify that.in the performance of thg,work for which this permit is issued; I shall not
=any person in any manner so as'to become subject to the workers': Compensation
Laws of California
' Dat
Sq. Ft. 1621 • No.
Size Stories
New ❑ - • Add'❑ Alter ❑
No. Dw
Units
Repair ❑
ii
Demolition ❑
Estimated valuation
-
$67,514
BY: - -
PERMIT
-
Minimum Setback Distances: ,
AMOUNT
Plan Chk. Dep. •
Front Setback from Center Line
%.
Plan Chk. Bal.
�- • r ,r 4W. IT.
Const.
Side Street Setback from Center Line
Mech.
.1•
E ,WD
Electrical
104,00
Plumbing,
123.00
S.M.I.
FINAL DATE
F 6:16
Grading
expiration if work thereunder is suspended for 180 days...•
,
Driveway Enc.
I certify that I have read this application and state that the above, information is correct. • '
.
Infrastructure
t'
1,969.07
construction, and hereby authorize representatives -of this city to enter the -above-.' '
mentioned property for inspection purposes..
- Y
,
Signature of applicant Date
„
Mailing Address .
Validation:'
TOTAL
p.3,3i3.
", `)'-Vt,�,, . •f �f
REMARKS
e Owner
NOTICE TO APPLICANT: • ff, after making this Certificate. of Exemption you should become
ZONE:
BY: - -
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith•
complywithsuchProvisionsofthisPertnftshe(/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
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.) '•.
-Side Setback from Property Line
Lenders. Name
,Lender's Address
FINAL DATE
INSPECTOR a
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,�Q/� y
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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE"�Z%
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF. �(p (Q O
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
WGAS (FINAL) `6o,7_yU
DRAINAGE PIPING
CAR P. SQ. FT. @
GROUT
WATER HEATER
DRINKING FOUNTAIN.
WALL SQ. FT.
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SO. FT.
GRADING
cu. yd.
$ plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP. d Itd 4.Q
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING ,/ fj
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
M'SCH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
, UND PLUMBING3 ��
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE"�Z%
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPTIC TA
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. �(p (Q O
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
WGAS (FINAL) `6o,7_yU
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. d Itd 4.Q
FRAMING t 3 (
FINAL INSP.
ROOFING ,/ fj
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR/
h
GAR. FIREWALL / � v
CCCJJJ
LATHING
MESH
INSULATIONISOUN ¢Q%
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL