06858 (SFD)•4 , V
P.O. BOX 1504 No. 06858
BU n Addtless 44-245 Sweetbush Lane. LA QUINTACCALIFORNIA 92253
Owner
La Qt3ieta Associates
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address $3-875 Washington St. A.P. Number Tract 22982 - Phase IY
City 92260Zip Tel' Cactus Flower
aIm Deser g22�345»7641 Legal Description
Contractor Project Description plain 4C Lot 122
E.G.' Williams Dev. Corp.
Address
Same
City Zip Tel.:
State Lic. City
& Classif. 4939:9 Lic. # 1231 Sq. Ft. 1887 No. No. Dw.
Arch.,-Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
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 Estimated Valuation
I hereby affirm that 1 am exempt from the Contractors License Law for the following$98,754.67 �
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 rile a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of - -
Division 3 o/ 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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than rive hundred dollars (8500). S -
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COnSt. 590.00
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, Mech.
provided that' such improvements are not intended or offered for sale. If, however, the building 53.50
orimprovement is sold within one year of completion, the owner -builder will have the burden Electrical g 't -
of
proving that he did not build or improve for the purpose of sale.) , q 613..71
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
strut• the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law �3.0
.00 does not apply to an owner of property who builds or improves thereon, and who contracts for S. M. 1. V
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. &, C for this reason Grading
t� Driveway Enc.
f '11e t 9 } Infrastructure r�s�
Date )! ' ' Owner tZ_B. &?I_.�'.�''.�',3� -�._- Lg22i.'IRS
WORKERS' COMPENSATION DECLARATION
I hereby affiim that I have a certificate of consent to self -insure, or a certificate of
Workers 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. e
TOTAL Ja�tV .ci� 0 ,
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE -. -^+ z•. +r•:: --•z ^; 1 cA}
(This section need not be completed if the permit is for one hundred dollars (3100) valuation .'+r fM.
or less.) -• ,,; rtl/M �GY i��{4.. ��' s.a=-
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: If, after making this Certificate of Exemption you should become ZONE: `F 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
Lenders Name
Lenders Address
FINAL DATE
INSPECTOR
This n a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
� S®� �
I certify that I have read this application and state that the above information is correct.
Issued by:
Date Permit
1 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
IST FL. SO. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SO. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF. 9� ��
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRAINAGE PIPING
CAR P. SO. FT. ®
LUMBER GR.
FINAL INSP. i�
FRAMING
FINAL INSP. /Q
DRINKING FOUNTAIN.
WALL SO. FT.
REMARKS:
URINAL
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
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
MESH
INSULATION/SOUND tp
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 ® 1Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 ELECTRICAL HEATING i£ AIR COND. SOLAR
SETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE %
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK' ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. 9� ��
GAS (ROUGH) 2 METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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. i�
FRAMING
FINAL INSP. /Q
ROOFINGS S /�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
Dw a?
LATHIN
MESH
INSULATION/SOUND tp
FINISH GRADING
FINAL INSPECTION•
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL