07413 (SFD)Building
Address
Owner
Suatfte
P.O. BOX 1504 No. 07413
78-105 CALLE ESTADO
uthem Hilts LA QUINTA, CALIFORNIA 92253
Address., 42-M . k St., Suite 200
City Zip Tel.
Contractor
Address
City Zip Tel: T
State Lic:'`; City
& Cla`ssif:. Lic. #
Arch.,'E'ngr,.:,:`'...
Designer.-. ,•;,'s .,'1,
Address:* :' Tel.
City. ' �; ' Zip State
x `h'. Lic. #
-:
_ .trv,-t�. �r ',, '•: >LICENSED CONTRACTOR'S DECLARATION
ere .
I hby 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'. °-, - - "I DATE
OWNER -BUILDER DECLARATION
I hereby affirm that'l 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).
0.1, 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 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
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 .thp work for which this permit= -is issued, I shall not
employ any person in any manner so as to become subject fo the Worlters' Compensation '
Laws of California,
/ - X7,
}r
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number P9A iiiast Phama 11
Legal Description
Project Description Tra'rt4`t 25,IM1 plum 31 jasl
Sq. Ft. No. No. Dw.
Size 2129 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolitiion ❑
See. pert 06362 for Fees..
Estimated Valuation
PERMIT.-. AMOUNT'
t
Plan Chk. Dep.
Plan Chk. Bal. .
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
1 ,
TOTAL
REMARKS
Date Owner
NOTICE TO APPLICANT: 'Jf,_aRer-•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. it - -
Minimum Setback Distances:
Front Setback from Center Line
Rear -Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby at 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
FINAL DATE
INSPECTOR
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.
3orrect. )���AA
I certify that I have read this application and state that the above information is'c
Issued by:
Date i 7CiPermit
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
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. Fr. ®
(ROUGH) . _T�j }
�V
j DRAINAGE PIPING
WALL SD. FT.
OTHER APPIEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
NAL INSP. l l
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
ZV ` �w
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SO. Fr. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 V. c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.Fr.GAR ® 3/ic
HOUSE SEWER
THING —0—
—MESH
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
494WUND PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSS
0
WER OR SE I
v9
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINFL —1S
(ROUGH) . _T�j }
�V
METER LOOP
HEATING (FINAL)
OTHER APPIEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
NAL INSP. l l
401_/FRAMING,g—' Q —�
FINAL INSP.
ey ROOFING
. 112 �
ZV ` �w
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING —0—
—MESH
MESH
0//41,1SULATION/SOUND l l V
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL