06144 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-665 Vallejo LA QUINTA, CALIFORNIA 92253
Andy Yslm®
Mailing
AddressP.
City lZip ITel.
Contractor
No. 06144
JILDING: TYPE CONST. OCC: GRP.
P. Number 774-281-021
Legal Description
Project Description M
Address
F. €3. Box 36-29 -�
City
Zip
Tela
Film Desert
92260
399--5350
State Lic-
City
& Classif.
Lic. #
Sq. Ft.
Size X7
No. No. Dw.
Stories Units
Arch., Engr-,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed•under provisionsof Chapter 9 (commencing with Section
7000) of Division3 of the Business and Professions Code, and my license is in fulll'force and
effect- ; :� r f • , f �"� , ,�f �/ Yui
f
SIGNATURE i*«J' M DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Lafor the following
reason: (Sec. 7031.5,tiusmrness and Professions Code: Any city or countywhich requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the appficant 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 that. he is exempt therelmm, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenafty of not more than rive hundred dollars ($500).
❑ 1, 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
Estimated Valuation
$87,010'
PERMIT
' AMOUNT
Plan Chk. Dep.
$250.08
Plan Chk. Bill.
r • ij ,
Const.
�i3 J. 5101
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-bulider will have the burden
of proving that he did not build or knprove for the purpose of sale.)
Mech.
;.�� ou
Electrical13.33
`
Plumbing
�ry
178-50
❑ 1, 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 contractors) 8censed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. ti P.C. for this reason
S.M.I.
6.16
Grading
20.01011
Driveway Enc..
253.,00
Date owner
Infrastructure
1,,.919-46
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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��`3 Ji "l company 1'/o 1r ` f t,er E, 7�lyC
Le Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
$3,488.47 1 J
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of th? 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 APPLICANT. ff. after making this Certificate of Exemption you should become
subject to the Workers' Convensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shag be deemed revoked.
ZONE: BY: -
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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.)
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration i1 work thereunder is suspended for 180 days.
FINAL DATE
w
INSPECTOR
t
� ` 789
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 prop erty for inspection purposes. -
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
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 SO FT ®
ROUGH WIRING
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GAS (ROUGH)
METER LOOP
DRAINAGE PIPING
CAR P. SO. FT. ®
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN.
WALL SO. FT.
GROUT
WATER HEATER
URINAL
SO FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
$
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE I DRYER
ROOFING i
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, 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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
BdECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK i i
�6ROUND PLUMBIN - l -C y
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
ORMSiii
L R SEPTIC T
you
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
-Plus-X$-=$
LUMBER GR.
FINAL INSP. !/ j f%O
/
FRAMING
FINAL INSP.
ROOFING i
4,�- '4 G , q �n
�`/! v�
/_ /A�
7�/
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING f�/lY�✓ / �O
MESH
INSULATION/SOUND a
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
1
I
Desert Sands Unified School District
CERTIFICATION. OF PAYMENT
OF ; �0
SCHOOL FACILITY FEES
Noi'dcE: THIS DOCUMENT
w
A CANNOT !�
TO: City 80 P(Q101 ilG'ATED, DATE: O" I O ji
tin)
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
i
This is toertify t
developer of t ( which is
located at -� Q within
this District, has paid school facility es imposed .pursuant to the
ty g era d by overnme t Co a Sec iot 53080 in lthe• amount o�
(ff�
covering a total of square feet of ( ) residential' or
( ) industrial/commercial development and that building permits-for
this footage in this development may now be issued by your jurisdiction.
5Y --905 Uw • C,Q�,i, c�.
fo DESERT NDS UNIFIED!, SCHOOL DISTRICT
i
White Building Department • Yellow - facilities Planning • Pink - Accountings • Gold - Developer
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Recelved From, r ��-►1� w� 1 CA h ` t S f'� ' ~- / I
Addreee: Data
)(Account No. kpo lo` 1 21 \ ✓ '7 U,'�. Lotle) �' .; ��.. „E, SCM
Tract
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+ � uG.A. Code 7 motor(&) I r .l � `� C� t U � J N ✓ V ^I
IS
O Bacylow(e) !,l
U Houde Lateral(e) � •-
U Detector Check(&) `
U MatwSuroher9e• /
Sanitation Capacity Charpe • 6�. i S'iS� —�`' lv SUV of /'1
❑ W.S.B.F.C.
I?
O Temporary Construction Mater
Li Turnon.Charpe,
❑ UncolleotedAcoount-Name
❑ inspectlonFee-Tract-
Foe -
O Plan Check Fees Water! Sawor -
Traol - r'
❑ Bond Payment - A.D. - dond���
Aeemt
O CuetomerDeAaelt ,•
U Other,
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Remarks:
❑Copy
^��tD��
to;L�
rl�1�f�P •'
Cash
Check
_.
Money
Order
a�P�yBQa�Y�"
TOTAL
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