03924 (RPL)4,4 0,924
4� P.O. BOX 1504
Building 54-94 Val
Address le LA QUINTA, CALIFORNIA -92253
Owner _
ftb I-ya h
Mailing
Address 56-'940 VA:
City lZip
Contractor
20th CentUry PE301S
Add
BUILDING: TYPE CONST. OCC. GRP.
A.P.;Number
Tel.
Sha" 6xio Legal Description
Project Description Pool
ress
577 gunny Dunes Road I I i. � t .• :. ,..:,
" v
ti a . � � : , , �.....
CityZip
Palm springy
92262
Tel.
144-:X4 2 3.. � ..
q
State Lic.
City
& Classif.'420476
Lic. #
Sq. Ft.
No. No. Dw.
-
""
Size — ' " ' " "
' ` Stories ' Units
Arch:, Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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 Prot9ssssiions Code, and my license is in full force and,
effect. ��/Jv.. r/ �Ir "f'y��
,
—<t
SIGNATURE N {' f DATE''
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
pyrR
0,000' '
. reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
. repulres 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
PERMIT
'
AMOUNT
Division 3 of 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 anyNapplicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Dep.
Plan Chk. Bal.
,
COr1St.'
g 00
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
Mech,
-
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.) ..
EleCtrlCal
,� y '
Plumbing
20.00
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 town owner of property who builds or improves thereon, and who contracts for
S.M,I,
.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
' O I am exempt under Sec. B. 8 P.C. for this reason
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION``1`�
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
O Copy is filed with the city. O Certified copy is hereby furnished.
'
,TOTAL
I 1.1V "4� , /yi '
'
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
'REMARKS
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
' or less.) -
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. -
' ` .r f o;�W
..
Date—Owner
NOTICE TO APPLICANT.., If, after making this Certificate of Exemption you should become
• subject' to, the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE:
Minimum Setback Distances:
- BY:
- -
-.
Front Setback from Center Line '
Rear Setback from Rear Prop. Lirie
CONSTRUCTION LENDING AGENCY
:' '
Side Street Setback -from Center Line
I hereby affirm that there is a construction lending agency. for the performance of the
work for which this permit is issued. (Sec.'3097, Civil Code.)
Side Setback_ from Property Line
Lender's Name
Lender's Address
FINAL DATE `
,
--.;--INSPECTOR
p
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.,
I certify that I have read this application and state that the above information Is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of. this..city to 'enter the above-
mentioned property for inspection purposes.
Issued by:Date
'•
Validated by:
Permit
1
.r '
Signature of applicant Date
Mailing Address
Validation:
+� City, State, Zip
`WHITE -,FINANCE, PINK =. APPLICANT; GREEN - BUILDING;
.'. �.. ..,u: ._.:✓ . , .. .-..+:} d..d ��?C:!P.+ v� _�te ,.. _ _.. it ni r. �%•r': ,♦ .. ��::Ti '�:;__".i�.. �. �„'t.'!l.':
GOLDENROD -ASSESSOR'S OFFICE HARD COPY - FILE-
•. i::.'1�.. ".i+ • �'s.' � .moi-.«. _ w_ e .t=:, _'� _ ..,w.a t ¢}_$' -..,.. . �.I " __ •... •\'. _- ._
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (a S
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. C
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT at
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. C1
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. 6
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. Q
LUMBER GR.
FRAMING
URINAL
SO. FT. a
� g— �J N
1 /
LLL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WAS HER(AUTONDISH)
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, 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 Q 14: c
SEWAGE DISPOSAL
SO.FT.GAR 3i.c
HOUSE SEWER
FENCE FINAL
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
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./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. / 7�
GRADING
cu. yd.
Plus—X$—=$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
� g— �J N
1 /
LLL
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESI.NITIAlS
GARDEN WALL FINAL