12804 (SFD)44 uGl'ItrCv
P.O. BOX 1504
Building 78-960 La Palma Drive78-105 CALLE ESTADO
Address . LA QUINTA, CALIFORNIA 92253
Century Hames Communities
Mailing
Address 1535 South eft* S'Lreet# Ste. 200
City Zip.Tel.
San Bernardino, CA 9240(909) 38,1-6007
Contractor
Sme
Zip
State Lic. B 314473 ( City 2120
& Classif. Lic. #
Arch., Engr.,
Designer Benjamin Aguilar A ASSOC.
,
V49Y Passero Avenue Ti -710 359-6Q66
City Zip State
1yyerside,.--CA;' 92505 Lig. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under-pr_6'V&ons-of,Ctiapter 9 (commencing with Section
�f000) of Division 3 of.-theBusiness__atid-Professions'_Coile, and my licegse is`ih full force and
Y1GNATt1RE" elf�..�•+^' �- ......
DATE
OWNER -'BIDER 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 which requires a
permit to construct, alter, 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 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 dollars (3500). `
❑ 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, Bulsness 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.)
❑ 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 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 � mpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy Ngo. Company
CliCopy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COM PENSATIO N INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, 1 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 or 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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 12804
BUILDING: TYPE CONST. -OCC '
ONST.OCC: GRP.
A.P. Number 604-161-046
Legal Description Lot 71 `L'7Cc'ic 23269 Phase 7A
Project Description 3FD Plan 3X
La Quinta Del' Rey
Sq. Ft. No. No. Dw.
Size 1606 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $93,171.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
268.13
Const.
612.50
Mech.
_
49.00
Electrical
127.75
Plumbing
144.00
S.M.I.
9. $Q
Grading
20.00
Driveway Enc.
00
Infrastructure
- 2, 058.10
TOTAL
3#539—.88 3, 2838. X38
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
A
FINAL DATE INS
Issued by: Date 11" Permil
Ie
Validated by: �L IWAR 0
Validation:
CONSTRUCTION ESTIMATE
NO:- ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. Q $
UNITS
A.C. UNIT
�~ r
�
SLAB GRADE 2 \
YARD SPKLR SYSTEM
2ND FL. SO. FT. Q
ROUGH PLUMB.
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. Q
SEWER OR SEPTIC TANK
GAR. SQ. FT. Q
POWER OUTLET
ROOF DRAINS
FOUND. REINF. (
DRAINAGE PIPING
CARP. SQ. FT. Q
HEATING (FINAL)
OTHER APPJEOUIP.
WALL SQ. FT. Q
DRINKING FOUNTAIN.
I SO. FT. Q
URINAL
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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
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. Q c
BATH TUB
SQ. FT. Q c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID Q 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR Q 3/ac
HOUSE SEWER
LATHING Q
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 PLUMBINGE TRICAL HEATING & AIR COND. SOLAR
1 1 �a„
SETBACK
GROUND PLUMBING 1
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 2 \
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 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.
FRAMING! 3' �
FINAL INSP.
ROOFING Z
VENTILATION
/ ) ✓P�
a_4V1 r v
rp Li (V
/
Zil 9 L
o
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING Q
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
_:LSI �.�.t ... ... _ .._t.... `3] ..:iX• ._. _. .,� `X; �... .� _3 `cv�.�_..,....f_ ,.'A.. F'.- --.-�s:- __ _.-w.,.w .,. _. ..«..�.. _,_...k _.,.. ...._s ,., i..
Ik
OF
C r u a (Quinta
C;Z)aet� t t Van
guab* M auk f43 1
J t
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building!
H
Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 78-960 LA PALMA DRIVE
Single Family Dwelling 12804
Use Classification -Bldg. Permit No.
Group R3 Type Construction VN Fire Zone Use Zone SR
W
Owner of Building Century Homes Commun it ie address 1535 Sniii-h "T)" St-rt-t-f., sfp- 2nn
City San Bernardino, CA 92408
By,. Bruce Pelletier
Date; July 8, 1994
Building Official
PftT IN A CONg"CUOUS PLACE