13952 (AR)i .
P.O. BOX 1504 No. 3,952
Building 54-007 Southern Hills 78-105 CALLE ESTADO /
Address LA QUINTA, CALIFORNIA 92253
Owner E.. Chadwick P#iOt3ney'
Mailingb BUILDING: TYPE CONST. OCC. GRP.
Address Sable
A.P. Number
City Zip Tel.
La Qui nta, CA 92253 .771--0925. Legal Description
Contractor Project Description Addition/a embdei
The gleine Co..
Address .
78-71.0 Av. La Fonda 1,
CityTel.:
e IZ192253
L.�564-3455
State Lic. City
& Classif. 390365 $ Lic. # on Sq. Ft. 15$ No. No. Dw.
Size Stories Units }
-Arch., Engr.... .. _ ._ -. _ __.M;
Designer An
derhblt New ❑ Add ❑ Alter ❑ Repair ❑ Demolitiori ❑ � .
-Address Tel.
Cifyf? Zip State s.
Lic. # =':f
LICENSED -CONTRACTOR'S DECLARATION �x
"s ;
I hereby affirm that•I�am•licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3e`Busrness and Professions Code, and my license is in full force and
effect +�'1✓
SIGNATURE /J' DATE '
'
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation $120,24.00
reason: (Sec. 7031.5,Business and Professions Code:. Any city or county which requires a t�
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 PERMIT AMOUNT -'
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 Plan Chk. Dep. e�
subjects the applicant to a civil penalty of not more than live hundred dollars ($500). Plan Chk.• BBI. - 3 t:0
1:1I, 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 Const. 00
Professions Code: The Contractor's License Law does not apply to an owner of property. who •
builds or improves thereon and who does such work himself or through his own employees,�� /�!*
provided that Mech. such improvements are not intended or offered for sale. 1l, however, the building 00
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 't 20.53. •,, •';
of proving that he did not build or improve for the purpose of sale.)
.. O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing .00
strucl'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.I. 1.23
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
' 10 1 am exempt under Sec. B. R P.C. for this reason ,
_ Driveway Enc. figg•
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
all
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 - � •�,t,
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 28+0.36
CERTIFICATE OF EXEMPTION FROM REMARKSa
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars ($100) valuation i' y
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
fv
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY: Y
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
_Eomplywithsuchprovisionsorthispermitshallbedeemedrevoked. Minimum Setback Distances:
Front Setback from Center Line_
Rear Setback from Rear Prop. Line;
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
—
1 hereby affirm that there is a construction lending agency for the performance of the . -.1}�+
,work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address I(,/�/
FINAL DATE
This is'a buildingINSPECTOR
permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. v /7
1 certify that I have read this application and state that the above information is correct. Issued by Date
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 theabove-. 1 �1 /f / / ?
mentioned property for inspection purposes. Validated by:
Signature applicant Date \ rte
•r• -Mailing Address
ress- Validation: -
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
r
COLL, AREA
YARD SPKLR SYSTEM
2ND FL. SQ. FT. Q
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
FORMS
SEWER OR SEPTIC TANK
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
expLIND. REINF�— /
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ. FT. ®
WALL SQ. FT. ®
OTHER APPJEQUIP.
DRINKING FOUNTAIN. ►
GAS (FINAL)
URINAL
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR./�
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMIN —/ L
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
expLIND. REINF�— /
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
p�
6 �" —G
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR./�
_ / ('7 �/l
v [ f
NAL IN
FRAMIN —/ L
FINAL IN
ROOFING
/t
�Go/%% / 1 A-V../
i— ��/ i=i
07, O'Vl
l
/
/'v Q�/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
FIREWALL
�'G"AR.
&LATHING
MESH
INSULATION/SOUN _,,1®
FINISH GRADING
FINAL INSPECTION 0. 1 —
1
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL