05438 (SFD)TA 1"4
P.O. BOX 1504
No: 0,54.3 = •I
Building 7&105 CALLE ESTADO � "• . ;
Addresst15 '�$ LA QUINTA, CALIFORNIA 92253 "
Owner
CO' BUILDING:•TYPE'CONST. OCG GRP.' .'_..'
Mailing 42-600, S 2l� r
Address •...
A.P. Number
City F Zip � 25t} Tel." $ � " ,• 4 Legal Description %, LL IES
.. _
Contractor Project Description G3.BR PHASE 1
Address qtr$
AM.. _.x .
City Zip Tel.:,
State Lic. City.,
& Classif., Lic. #
288130SQ Ft. 3831 Q No. No. Dw.
.
Arch.,•Engr.; .
Size' - Stories' Units '
Designer ' New ❑ Add ❑ Alter ❑ Repair'❑' Demolition ❑
Address' •, Tel..
City Zip State: _
Lic: #
;.LICENSED CONTRACTOR'S DECLARATION ?' e
i 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section " t
70pp) of Division 3 of the Business.and Professions Code, and my license•is in full force and, ;
r•.�.
�._ •%^ :''�;C_.%�.� _riff f ,�,n
SIGNATURE r' DATE - -
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that 1 am exempt from the Contractors License Law for the following -2n,,603
reason: (Sec.-7031.5,Brrsonass and Professions Code: Any city or county which requires a
permit to construct, alter, unprove, demolish,, or repair any structure; prior to its issuance also -
requires the applicant for such permit to Ole a signed statement that he is licensed'pursuant to PERMIT - - AMOUNT
the provisions of the Contractor's License Law, Chapter 9. (commencing with Section 7000) of -
Diviston 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 Plan Chk. Dep. .
subjects the applicant to a civil penalty of.not more than rive hundred dollars (5500). Plan Chk. Bal.. •
❑ 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 r
Professions Code: The Cordractors License Law does not apply to an owner of property who Const. .qL
builds or improves • thereon and who does. such work himself or through his • own employees, Mech.
provided that suchorrprovemenfs,are not. intended or offered for sale..lf, however, the building -
,f or improvement is sold within one year of completion, the owner -builder will, have the burden Electrical - L'i'• ` -
C
proving that he did not build or. improve for the purpose or sale.)
O I, as owner of the pm roperty,aexclusively contracting with licensed contractors to con- Plumbing P}.,.
• strut( 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 S,M"1. - -,'.•.
• such projects with a contractors) licensed pursuant to the Contractor's License Law.) - - -
Grading
0 1 am exempt under Sec - B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure a•?'
Less t I o:. l3.UUT
WORKERS' COMPENSATION DECLARATION offa. Due 3 Q , ..
I hereby affirm that I havea certificate of consent to self -insure, or a certificate of
,r Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company -
O Copy is filed with the city. .O Certified copy is hereby furnished.
TOTAL.
CERTIFICATE OF EXEMPTION FROM REMARKS
r WORKERS' COMPENSATION INSURANCE
(This section need not be completed fL the permit is for one hundred dollars ($ 100) valuation. ;1.-1;:?''f �� },j l ;¢ "�Syta'"'t� ,� , •. �7•.
or less.) .
- I certify that in the performance of thg 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 APPUCANT. ff, after 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 orwspermit shall bedeemed revoked. Minimum Setback. Distances: •` '• -
Front Setback from Center Line '
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from'Center Line
1hereby affirm 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
Lenders Name :
Lender's Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to t
expiration if work thereunder is suspended for.180 days: 3',3Qt9
I certify that I have read this application and state that -the, above information is correct. Issued by:`µ y'• '
I agree to comply with all city and county ordinances and State laws relating to building Date Permit
construction, and hereby authorize representatives -of this city to enter the -above-.
mentioned property for inspection purposes Validated by: '
Signature of applicant Date' c; ,
Mailing Address Validation:
City,. State_ Zip s
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
LAB GRADE2
ROOM PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
FORMS
ER R SEPT
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT, ®
GH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
or GROUT
DRAINAGE PIPING
CAR P. SQ. Fr. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SO. FT.
LUMBER GR.
FINAL INSP . / L
Il ��
l
URINAL
SO. FT.
1i
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
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
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
R. FIREWALL
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
FINISH GRADING
SQ. Fr. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. Fr. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ec
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 GOND. SOLAR
VTBACK
D PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE2
ROOM PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER R SEPT
ROUGH WIRING.
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
EI F. STEEL 5
GAS (FINAL)
TEMP. POLE
or GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ -plus-x$-=S
LUMBER GR.
FINAL INSP . / L
Il ��
l
FINAL INSP.
V
1i
REMARKS:
VENTILATION 11
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
R. FIREWALL
LA ING /
ME
NSULATIONISOUND7
FINISH GRADING
L INSPECTIO bo
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL