05430 (SFD)P.O. BOX 1504
Building_ 54— SOUTHLS. LA QUINT
Address A, CAL FORNIA 92253
Owner
SMMISE COIIPA14Y
Mailing
Address 42.600 WOK. STE 200
City Zip Tel. .-.,.
PAY DIESEL , 92265 56072828 ,
Contractor
Address
No. 0434
BUILDING:.TYPE CONST. OCC: GRP.
.Number-, ' -
Legal DescriptionG3 Bn 1E
Project Description PHASE
_ SFD
SAID
CityTel.:
PAW �
S
ip
92260
F
State Lic.28�, ��
& Classif.
City . 2��
Lic. #
Sq. Ft.
Size 3831
No. No. Dw.
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address `o,
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 r' . r'- ✓
f
'
SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec.. 7031.5.aysbtess and Professions 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 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 Businessand 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 penalty of riot more than rive 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 iiproves 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
proving that he did not build or bmprove for the purpose of sale.)
Estimated Valuation
r�y2�
PERMIT
AMOUNT
Plan Chk. Dep.
'
Plan Chk. Bal.
•
Const.
•
Mech.
Electrical
Z00.45of
Plumbing
❑ 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 builds 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 B. & P.C. for this reason
S. M.1.
cLs1
.T A•
Grading
Driveway Enc.
Date Owner
Infrastructure��+,fig
S QW11U,;r
. t3
WORKERS' COMPENSATION DECLARATION
1 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 if the permit is for one hundred dollars ($100)' valuation
or less.)-
certify that in the performance of thip 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
aliforniaDateOwner
NOTICE TO APPLICANT N, after making this Certificate of Exemption you should become
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.)
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.
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
INFRA Dub
'
f
TOTAL -T 1
i..-4 t
REMARKS +a +��►.vv
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 3/3189Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
r /
ROUGH WIRING
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. @
OUGH)M121710%
METER LOOP
DRAINAGE PIPING
CAR P. SQ. FT. ®
EINF. STEEL
GAS (FINAL)
TE . POLE
DRINKING FOUNTAIN.
WALL SQ. FT.
GROUT
WATER HEATER
URINAL
SQ. FT.
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
$
FLOOR DRAIN
MECHANICAL FEES
LU GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® VAc
HOUSE SEWER
MESH
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
ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. ir
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPT
r /
ROUGH WIRING
DUCT WORK
ROCK STORAGE
F ND. REINF.AS
OUGH)M121710%
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
EINF. STEEL
GAS (FINAL)
TE . POLE
GROUT
WATER HEATER
CE P �'
FINAL INSP.
BOND BEAM
WATER SYSTEM
/
$
GRADING
-ER cu. yd.
plus x$
=$
LU GR.
FINAL INSP.
RA G
FINAL INSP.
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
17IQR. FIREWALLL�
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL