9970 (SFD)4.4
is / P.O. BOX 1504 N O .
BuildinAddress f "lam �! /_%YI.i� e 78 105 CALLS CALIFORNIAESTAD9
LA QUINTA, ORNIA 92253
Williams Development Corp 'BUILDING: TYPE CONST. OCC: GRP.
Address 42600 Cook St.
City Zip Tel.
Palm Desert 192260 345-7541
Contractor
Address
Zip
State Lic. City /
&Classif.} l Lic. # l 9/
Arch., Engr., l
Designer 5toffregen Fuller
Address Tel.
.31728 Rana Viejo Rd 714/493--0660
City Zip State
San Juan C€aplistrano 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`tfie 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 Code: Any city or county whlch,requires a
permit to construct," atter, improve, demolish, or repair any structure; prior to lls�lssI , Ice 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 that. he is exempt therefrom, and the be
'.:/o/'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).
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 copy thereof. (Sec. 3800, Labor Code.)
Polic No. Company
ar]_ 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 -
oriess.)
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: 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
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.) .
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 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.
Signature of applicant Dater
Mailing Address
City, State, Zip
9970
A.P. Number ) p r
Legal Description r! 01i r
Project Description Model #2
REMARKS
ZONE: BY:
Minimum Setback Distances:
- Front.Setback from CenterNLine , r'
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:
Sq. Ft.
Size �.��
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition 0
Permit does
nfct include
block walls or
,foal
4'
Estimated Valuation
105062.90
PERMIT
AMOUNT f
Plan Chk.,Dep'.
250.00”
'I
Plan Chk. Bal.
309.96
Const.
660.50 4
Mech.
49.50
Electrical
Plumbing
i6.. 00
S.M.I.
10.60
Grading
20.00
Driveway Enc.
270..00
Infrastructure
2350.95
Arts in Public °
.25.00
TOTAL
. 3 9`9 `Y .'7_9
_ .,. • 3 7 4 7 .7 9
REMARKS
ZONE: BY:
Minimum Setback Distances:
- Front.Setback from CenterNLine , r'
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. ® $
2ND FL SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
1
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
a
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROCK STORAGE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SO. FT. ®c
IWATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
GRADING
cu. yd.
$ plus x$
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 f PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING `
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
a
ROUGH P UMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEW
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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.
FRAMING .2— 41�J 1,0
FINAL INSP.
ROOFING 128(y
i
REMARKS.
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
n
LA ING ! A
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
CITY OF u► OUINTA
DEPARTMENT OF PLANNING & DEVELOPMENT
BUILDING DIVISION
564-2246
24-HOUR NOTICE FOR INSPECTIONS
Nnsr
mtractor
Bank Nulnbmr 9970
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
)B ADDRESS
mit does not include block walls
pool
TYPE OF INSPECTION I DATE I INSP.
)UNDATION & SETBACK f .,,
kIN GROUND SYSTEM
IOUND PLUMBING 1 11 /114,1 4f I / n
) NOT POUR CONCRETE UNTIL ALL AB VE HAS BEEN SIGNED
)NCRETE SLAB
LASTS & GIRDERS
.ECTRICAL GROUND WORK
) NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
)UGH ELECTRIC
)UGH PLUMBING
)UGH GAS & GAS TEST
EATING & VENT -A/C . 4,
)ND BEAM
K. TO WRAP
GOUT ❑ 4' ❑ 8'
LAMING
SULATION
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
RYWALL INTERIOR 431 A03
(TERIOR LATH
)OL PRE PLASTER
)OL FENCE & GATE
EWER SEfg46P *NK
FI
.ECTRICAL
.UMBING
NAL GAS TEST
EATING - A/C
)USE NUMBERS
)B COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
4/68