05976 (SFD)•
4
P.O. BOX 1504 No. 0976
Building 7&105 CALLE ESTADO
Address 55-413 .Southern dills LA QUINTA, CALIFORNIA 92253
Owner _ ....
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 75-005 Country Club A.P. Number MA NP -St
City Zip Tel.
P,D, 79221 156-0-2828 Legal Description
Contractor , _ , _ _ Project Description Phase I7$ Plan 40
Sam
Address
B,Classif. ;.58130 # 320
Arch., Engr:;
'. Designer'; -
Address ` Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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 Rotessions Code: Any city or county which requires a
Permit to construct, after, 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 penally of not more than five hundred dollars (E500).
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 unproves 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 forthe 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 Lxn7ds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. a• & 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 -
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 ($100) valuation
or less.)
1 certify that in the performance of the 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
Date Owner
NOTICE TO APPLICANT: IF, after making this Certilkate of Exemption you should become
Subject to the Workers' • Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this Perot shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
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-)
Lender's Name
Lender's Address
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 -
I certify that I have read this application and state that the above information is correct.
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
Signature of applicant Date
Mailing Address
City, State, Zip
u
Sq. Ft- 345 No. No. Dw.
Size Stories Units
NeWRM Add D Alter D Repair O Demolition O
Estimated Valuation 215.83•00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk- Bal.
e+)
Const.
•
Mech.
u •�
Electrical
153M
Plumbing
•
S.M.I.
• 12
Grading
Driveway Enc.
Infrastructure
•
Uso L,'rvul
2428,13
=ra DUO
REMARKSAIS
L�(g��.,r;A>♦R♦ircL+�r3- •��w{a=tjrY.f.,_ra, *%rf 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: DatePermit
Validated by:
Validation:
• V CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
LAB GRADE C
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
HEATING (ROUGH)
STORAGE TANK
F RMS
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
DUCTWORK
ROCK STORAGE
FOUND. REINF
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. ST
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
WALL Sp. FT.
WATER HEATER
DRINKING FOUNTAIN.
FINAL INSP.
URINAL
Sp. FT.
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
plus x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP3 7-fo
FLOOR DRAIN
MECHANICAL FEES
ING �C
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
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 ® 11/4, c
SEWAGE DISPOSAL
/
VeINSULATION/SOUND,Z- /k-
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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
S BACKOLIND
PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE C
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
F RMS
EWER OR
ROUGH WIRING
DUCTWORK
ROCK STORAGE
FOUND. REINF
GAS (ROUGH) --,�-g'61_
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. ST
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP3 7-fo
FRA INGFINAL
INSP.
ING �C
�n/�
t :/1/rn� (� A/C)
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
///'
7��G(LATHING � �—f o
MESH
/
VeINSULATION/SOUND,Z- /k-
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUReS11NITIALS
GARDEN WALL FINAL
,