04869 (RR)r
P:O. BOX 1504
Building 52-961 ValleJO78-105 CALLE ESTADO
'Address LA QUINTA, CALIFORNIA 92253
Owner.•
ftvridae Realtv (Escrow)
r' V BUILDING: TYPE CONST OCC. GRP. `
Mailing,
Address ;z ' 773-323-029, '
A.P. Number
City Zip Tel. +.
92253 773-: LegalDescription
Contractor. Project Description Teas ofd' Si re—roof
- -Armored P-a®f s , Inc.
Address.390, oleandia
'
City. - - -- Zip Tel.
iii , )a3Ce.lt � 92264 324�g3Q,4' r r » • ,
State Lic. City "
& Classif. • .Y $ Lic. # Sq. Ft.
' 'Size
Arch-Engr.,
Designer New ❑ Add ❑
Address - Tel.
City Zip State
Lic. #
f•
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. ,.. w � /e 4=
• ' ,fti.,,» .M:F:.�! f ^'rte 1 ..,1,1;5= 4 Yta .:'�•. F f L^' ..,d
SIGNATURE. - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law.for the following
'reason: (Sec. 7031.5,Business 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 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 theapplicantto a civil penalty of not more than five hundred dollars ($500).
0 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.)
O 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,'66py thereof. (Sec.,3800, Labor Code.)
Policy No. Company .1.1 1 1k-1
❑ 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.
No. No. Dw.
Stories Units
Alter ❑ Repair ❑ Demolition ❑.
z
stimated Valuation
$2o2401
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech..
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure ! !
TOTAL
REMARKS
A d Fid. ,#_t* �t �'.S, Y,. , ;•�,.. -.,,- ��,,rr y
R V .._L490rJr .1. o.r-c?tt1t;:_ "` y - Y•!ik v7 t tl ir' Ar7
Date Owner.
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
BY` '
subject,.lo the -Workers' Compensation provisions of the Labor Code, you must forthwith
-
Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
.r
Front Setback from Center Line
Rear Setback from Rear Prop. Line '
ti
CONSTRUCTION LENDING AGENCY
Side Street Setback,from Center Line
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.) _
Side Setback from Property Line�-
Lender's Name -
Lenders Address
FINAL DATE
1 1110 ,
INSNS
This is a building permit when properly filled out, signed and validated, and is subject to
r�PECTOR
q
expiration it work thereunder is suspended for 180 days.
� ,14
I certify that I have read this application and state that the above information Is correct.
Issued by:
Date Permit
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-
bove
mentioned
mentioned property for inspection purposes. -
Validated by:
Signature of applicant •' - Date
y •Mailing Address
Validation:
City, State, Zip
41
GOLDENROD - ASSESSORS
OFFICE, HARD COPY - FILE
4. WHITE FINANCE PINK APPLICANT GREEN BUILDING,
4_4_L �_ - t '��: ;.'1'',.10 .- ..r :.vl ,:� s s.i+.,.QS
.''•eY.+.
-) 1 r ^; s -I¢-^ :_t. --`a '�' t ., !. 't ,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO PLUMBING FEES
ISI FL SO FT !p $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SO FT. e
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FTat
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Cr
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. SO FT. 6
GROUT
DRINKING FOUNTAIN
WALL SO. FT. a
FINAL INSP.
BOND BEAM
URINAL
SO. FT. d
GRADING
CU. yd.
$ plus xE
=$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
—
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ERIAUTONDISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR rg 3i c
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
T07AL FEES
MICRO FEE
M=CH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 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
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus xE
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING �— 1
l
—
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
(. F.NAL INSPECTION&� - 64
11
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL