06042 (SFD)• '� r
414
P.O. BOX 1504 NO. 06042
Building' 54-75-3 Valle a7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
meadow Land Dev..
Mailing
Address B= 921
City Zip Tel.
Rialto 714 -875 --MO
Contractor
Address
City lZip Tel.
State Lic. I City
& Classif. 361079 Lic. #
Arch., Engr.,
Designer
Address Tel.
City(Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Gide: Any city or county which requires a
permit to construct, atter, improve, demofish*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 (commenting with Section 7000) of
Division 3of 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
subjects the applicant to a civil penalty of not more than five hundred ddfars ($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
be or improves thereon and who does such work himself or through his own employees,
provided that such mrprovements are not intended or offered for sale. h however, the building
orimprovement is sold within one year of comptetan, the owner -budder wig 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 Contractors License Law
does not apply to an owner of property who builds or brtproves 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 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
NOTICE TO APPLICANT: fl, 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.
�r
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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. '
1 certity that 1 have read this application and state that the above information is correct.
1 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. 776-281-M4
Legal Description Lot 12
Project Description S.F.D.
;Sews ,•
no seritic
Sq. Ft. 12�i
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
74,7. 00
PERMIT
AMOUNT
Plan Chk. Dep.
250.UU
Plan Chk. Bali.
Const.
•Z%
Mech.�:
Electrical
Plumbing
35
S.M.I.
• Z.:)
Grading
ZIII..O
Driveway Enc.
•LV
Infrastructure
its•
Pre ..im
'
TOTAL
! i
REMARKS
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
//SETBACK
( SLAB GRADFV —/ ✓
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
FORMS
�R10VTOMC�ANI
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SO. FT.
=$
LUMBER GR.
FINAL INSP. I� %
r
URINAL
SD. FT.
ROOFING(/y /�/�
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
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, TEM/PERM
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 Va c
SEWAGE DISPOSAL
FINAL INSPECTION
SO.FT.GAR ® 3/ac
HOUSE SEWER
CERT. OCC. !�
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 GOND. SOLAR
—/')_ f
GROUND PLUMBIt'g-6'
UNDERGROUND
A.C. UNIT
COLL. AREA
//SETBACK
( SLAB GRADFV —/ ✓
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
�R10VTOMC�ANI
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. I� %
r
FRAMING /// O
FINAL INSP.
ROOFING(/y /�/�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING / Zs �JO
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC. !�
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
NOTICE: THIS DOCUMENpAALftGn FEES
BE DUPLICATEDL . .
TO: City of La Quinta DATE: �q
Department of Community Development
78-105 Calle Estado1
La Quinta, CA 92253 All,�
%at
Eto certify hat (,C) rdevelwhich is
locat_ O c within
this District, has paid school facili y fees imposed pursuantto the
aut ity generat� by Gov rnment Co a Sectiolt 5308 in t @ mount of,
$ 4
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.
C� 143 6 61 17.64 c�
u -/- H3567- PtH E -9WPV&� 0, eftz22ft)
C]/ --:w 14 /b 563 for DESERT S qDS UNIF ED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37