05998 (SFD)44au�lttc� - • -
P.O. BOX 1504 No. 05-9198
Building 78-105 CALLE ESTADO
Address —819 Southern Hills LA QUINTA, CALIFORNIA 92253
Owner
rasa.
Mailing
Address 75-00.1, Ct9Emt" Club
City Zip Tel. .
Contractor
Sam
.Address
State Lic. I City
& Classif. Lic. #
288130
Arch., Engr,
Designer 3
Address Tel.
CityZip State
Lic. #
LICENSED CONTRACTORS DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
700 of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGUA Re DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8mrsimess and Roresshm Lode: Any city or county which requires a
permit to construct, alto, improve, demolish. or repair any structure, prior to its issuance also
requires the applicant for such permit to Me a signed statement that he is licensed pursuant to
the provisions of the Contractors License taw, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, of that. he is exempt therefrom, and the basis
for the affeged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a cht penalty of not more Oman five hundred dolim ($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 Contractors License Law does not apply to an owner of property who
builds or improves thereon and who does such work hirseft or through his own employees,
provided that such improvements; are not intended or offered for sale. lf, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
or 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, Bursimess and Prolesskos Code: The Contractor's License Law
does not apply to an owner of property who bnmkb or improves thereon, and who contracts for
'such projects with a contracta(s) licensed pursuant to the Cuxmactors License Law.)
❑ 1 am exempt under Sec ---_______EL g 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
0 Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be conpGrled if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, 1 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: 8, after making Ods Certificate or Exemption you should become
subject to the Workers' Compesation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit 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 property 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.
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 PGA, HeS8
Legal Description
Project Description Phase.19B Plan 20M
Sq. Ft. No. No. No. Dw.
Size Stories Units
New M Add.❑ Alter ❑ Repair ❑ Demolition ❑
(Estimated Valuation
1igaa1s.00
. PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure 4045.
Intra Due
TOTAL °& �L
AMOUNT
s � .
134 .2b
i• ci
- 9Lrs�
12*60
REMARKS .1&6w.4,n°'.i.e44V',-: i #.'*t xf,A 4 .49 ter J �
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 DAT INSPECTOR
Issued by: Date6-19—$9 Permit '
Validated bl:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. Fr. ® $
UNITS
SLAB GRADE
RO H PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT. @
FORMS40
ER OR SEPTI
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
S (ROUGH) J/
v
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SD. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SO. FT.
=$
LUMB GR.
ESTIMATED CONSTRUCTION VALUATION $
ING.
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
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
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR ® 3lhc
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
BACK
ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
RO H PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS40
ER OR SEPTI
ROUGH WIRING
DUCT WORK
ROCK STORAGE
D. REINF.
S (ROUGH) J/
v
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$
=$
LUMB GR.
(INAL INSP. ^ 47t)
ING.
FINAL INSP.
OFINGREMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
,ING i�
MESH
SULAT10NIS0UNDr�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUilES/1NITIALS
'
GARDEN WALL FINAL