06008 (SFD)P.O. BOX 1504 No. 06-10 V
Building 7&105 CALLE ESTADO
Address Sts 909 Swtberu U111a LA QUINTA, CALIFORNIA 92253
Owner
sloe ase Co. .
Mailing'
" BUILDING: TYPE CONST. OCC: GRP.
Address 75-W5 Comtry Cly K _ A.P. Number FCA Weet
CityZip Tel.
P.D. 93260 569-28-2-8 , Legal Description
Contractor Project Description Phalife 19D Plan 4MM
sire .... _
Address.
City ' Zip Tela
'' `'State Lic. City
"" ;8s�Classif:: 288130 Lic. # 32$ Sq. Ft. No. No. DW.
;Arch., Engr.,
Size 3142 Stories Units
f3`e§igner, 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
I hereby affirin that I am exempt from the Contractors License Law for the following
reason: (Sec.. 7031.5,Business and Professions Code: Any city or county which requires a
permd to construct, after, Improve, demolish, or repair any structure, prior to its issuance also
requires the app8cant for such permit to rile 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 cia7 penalty of nofmore than five hundred dollars ($500).
❑ 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 bnproves thereon and who does such work himself or through his own employees,
provided that'such brprovements are not intended or offered. for safe. h however, the budding
or improvement is sold within one year of completion, the owner -budder 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 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. & 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
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 9 the permit is for one hundred dollars ($100) valuation
or less.)
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: ff, after making this Certifirate of Exemption you should became
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
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.)
Lenders Name _
Lenders 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 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
u
Estimated Valuation. 213,834.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
'
Const.
_�
too•
Mech.
e
2.30
Electrical
133.47
Plumbing
210.
S.M.I.
5+
Grading
Driveway Enc.
Infrastructure
•
Less XM4111 r
2428.13
Infra Due,
2425.
TOTAL
REMARKS
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
GRADE
RO GH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. Sp. FT. ®
F MS
EW OR SEPT
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR, Sp. FT. ®
/'
OUGH) /
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
I
GROUT
DRAINAGE PIPING
CAR P. Sp. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL Sp. Ff.
LUM ER GR.
FINAL INSP.
URINAL
Sp. FT. @
OOFING ldREMARKS:
lb
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE fL.CK.FEE --[CONST.
FEE: ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SBACK
0UND PLUMBING? (
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE
RO GH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
F MS
EW OR SEPT
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REIN
/'
OUGH) /
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$-=$
LUM ER GR.
FINAL INSP.
NG l/
FINAL INSP.
OOFING ldREMARKS:
lb
alk
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GA FIREWALL/
RING LC
MESH
SU LT
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
l ?13_-5