11861 (SFD)P.O. BOX 1504 N o . 11861
Building 78-105 CALLE ESTADO
Address 52-A60 Vallejo LA QUINTA, CALIFORNIA 92253
Owner
General Contract "n.agjmpnt
Address P.O. Box 59
City - Zip Tel.
La Quinta, CA 1 92253 564-11486
Contractor
Cenekai Contract' Management
Address
P.O.* Bax 59
City ZipTela
La Quintao, CA 1 92253 564-1486
State Lic. ' ' City
& Classif: 524325 Lic. #. 1235
Arch., Engr:;
Designer.
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
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason:. (Sec. 7031.5,Business and Professions Code: Any city or i county which requires a
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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe 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 not more 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 improves 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
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 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.)
❑ 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
Worker's 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.)
I 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. r ••
Date Owner
NOTICE TO APPLICANT: If, 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
1 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 car Illy 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 774--6353--008
Legal Description Block 218 lot 17
Project Description SFD
Sq. Ft. 1732 No. No. Dw.
Size Stories Units
New QC Add ❑ Alter ❑ Repair ❑ Demolition ❑
Permit noes .not include block wall nr pool
Estimated Valuation *1063x282+061
PERMIT
I AMOUNT
Plan Chk!Dep.
Distances:
Plan Chk. Bal.
d +�
Const.
b43 + U
Mech.
02 ou
Electrical
x.
Plumbing
13-0 lio
.S.M.I.
lU a IU
Grading
Z0 + Ufa
Driveway Enc.
Infrastructure
2r 21is• •-U
irts In ub i
aces25.015
TOTAL
r +� t '3 •
REMARKS
ion
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
1ST FL. SO. FT. ® $
UNITS
T 1•
r
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH) 6 2l -134P
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) IZP e'1-14-23 0
TEMP. POLE 21(1
DRAINAGE PIPING
CARP. SQ. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SQ FT ®
_$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING 3/13 44)
WATER PIPING
NOTE: Not to be used as property tax valuation
n� (GJ ll (/ 3
C
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
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.
SQ. FT. ® c
BATH TUB
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
FINAL INSPECTION(l—Z3 3
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
GARDEN WALL FINAL
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING a
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
FOUND. REINF.
GAS (ROUGH) 6 2l -134P
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) IZP e'1-14-23 0
TEMP. POLE 21(1
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. —7—If:'23
FRAMING 3/13 44)
FINAL INSP. /t -'23-C/5 ko
ROOFING L n .r, 10r�/�
l
n� (GJ ll (/ 3
C
REMARKS:
VENTILATION
FIRE ZONE ROOFING .
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING ` 3
MESH
INSULATION/SOUND 2
FINISH GRADING J
FINAL INSPECTION(l—Z3 3
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURE'S/INITIALS
GARDEN WALL FINAL
rAA
P,O. fm $Q bf
IL
L
T"6 4"" No' '54629`24
ABOYd YHIV to Mi 000 "deepota-S wes
(11RANT DEEO
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COUIpm-11 W) the (VII 7641 �d 11.;.1tlVW4
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FOR A' VAIAIAMIX 4;A0%I11;WAT)tiN- mmiwl A
1'19VIAN M, Totpc
IND SiCtfN WALES, IIU.566,11D AND WE AR C%MtT? 40PUTY
U1;-Afyf,L CM7ACT WAOf)CNTI 6 CGNSPAL POOMMIP
[I. tk, 'IA •!nc illwl•fsuI 1"lWny lot ILC JC I&
FAKCCI, I
;-M' 17 ' A WPCK 218 lirqa Carmclico at VQIO IA NiOtll, Unj t ;I!; K r mo
I I -e of the Cii-MY Rce- Jul -Of 311W &t%vt
k• Iw.hto tM office
TIMM. 2:
L(Y r IGAA A I Ck at Wit La Quiip;a. Unit r.."wdod
in 061t 10 of movai In the of ftco vi %ho C.,Ytbtg Rolcoqdus: of WAid UUn'Cy
Z-
it -
Cit. ..4 —4101411.
To if.4 1- 40-411 9P TICOM TIME INSURAKIE
rOps s1vtt'slaff
lift 94ptitabor 2L. 140? l'O'llif in PftJ CA
J C49W
of —41`44,wr
pcow"
1334
JVtJ t0i1 11_, E� r.f• �\9��� fDY41(i;Cl fUf EOCH rs+w«
vulci 04� w
rvj r
Received Fro L•G�/L / / /'7 ui �fi
Date.
Address: �j
Account No. a Q o (s) �` Tra (ti'715Q
��S//ervice Address r'`f L G.A. Code
pQ Meter(s) �/ �! $ ,
�<Service(s) i — /. �� e
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge
P<Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account -Name
❑ Inspection Fee- Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - ' Bond
Assmt.
❑ Customer Deposit
❑ Other
t TOTAL $,
Remarks:
❑Copy to:
Cash Water Servica,��
Check
Money
Order Cashier
dvwb-438 (11 /89)
CALVIN C. KAMINSKAS
Assistant Commissioner
(714) 275-3000
: DAN RILEY
o ' Sealer, Weights & Measures
v
a t (714) 275-3030
OFFICE OF
AGRICULTURAL COMMISSIONER
JAMES O. WALLACE, Commissioner
83-612 Avenue 45 Suite 7
DATE -Z ' CASE NO. Ci C?iS VA
DEVELOPER'S NAME: (M
ADDRESS:
TELEPHONE
Dear Developer:
After reviewing your landscaping plans, -all plant material listed.is not in
violation of quarantine laws governing the Coachella Valley..'If substitutions
do occur.and they differ from plant material -listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.'
04
A icult al Commissioner's Office
cc: Indio and,Riverside
4080 LEMON STREET, ROOM 19, RIVERSIDE, CALIFORNIA 92501 -. FAX (714) 275-3012