06849 (SFD)44
P.O. BOX 1504 N o .
Building LA UINTACAL CALIFORNIA 92253
Address �0 Stiii@�'tbLiS�3 �19e g 8-105 C
Owner
La Quinta associates
Mailing 1
Address 43-875 Washington St. a
City Zip Tel.
Palm Desert 9.2260 7541
Contractor
E.G. gi l l i am' s Dev. Coro.
Address
City
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,Business 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).
0 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 owner of property who -
builds or= 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 butlds or improves thereon, -and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec B. & P.C. for this reason
Date !J 4/ Owner
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
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 if the permit is for one hundred dollars (S100) .valuation
or less.)
I certity.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
aliforniaDateowner
NOTICE TO APPLICANT: M, 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.
CONSTRUCTION LENDING AGENCY, -
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.)
Lender's Name
Lenders Address +
This is a building permit when properly filled out, signed and validated, arid is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 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
Mailing Address
City,. State, Zip
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number Tract 22982 - Phase IV
Legal Description_
Project Description_
Cactus Plower
Plan 2C ''Lot 1131
v j �
� S. x•t f,.•r,aAYr w a+xa�a��7k., + .a�t9..°�°•�t,
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft. 162No.
Size
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
,
Issued -by:
Date'l1t)/9() Permit
Validated by:
Validation:
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
-
488.77
Const.-
585. 50
Mech.
53.50
Electrical
104,00
Plumbing
12.3„0
S.M.I.3.
Grading
Driveway Enc.
Infrastructure
11969-07
TOTAL
3J—u U
i) `1 € ,j ,a 7 -
� S. x•t f,.•r,aAYr w a+xa�a��7k., + .a�t9..°�°•�t,
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
,
Issued -by:
Date'l1t)/9() Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
A.C. UNIT
COLL. AREA
IST FL. SO. FT. ® $
UNITS
BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
S ER OR SEPTIC
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SQ FT ®
GAS (ROUGH)' 2 ZD C
T
METER LOOP
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. @
WATER HEATER
SERVICE
FINAL INSP.
DRINKING FOUNTAIN.
WALL SQ. FT.
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
URINAL
SQ FT ®
FINAL INSP./Q
(
FRAMING 6 QDD
ESTIMATED CONSTRUCTION VALUATION $
ROOFING Qj Q�
VENTILATION
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
SPARK ARRESTOR
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
INSULATIONISOUND
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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 & AIR COND. SOLAR
SETBACK
UND PLUMBIN _ /
UNDERGROUND
A.C. UNIT
COLL. AREA
lJf
SLAB GRADE 31 Z3 QV _
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
S ER OR SEPTIC
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF3 �� 90
GAS (ROUGH)' 2 ZD C
T
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./Q
(
FRAMING 6 QDD
FINAL INSP.
ROOFING Qj Q�
VENTILATION
./
�Y�
�}
/`
D�
REMARKS:-
EMARKS:VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL O
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t