08655, 09270 (SFD)I
Building
Address 4`r42Q Def=
Owner
Mailing
Address 859 13. MMMt&ln AVO #155
City lZip ITel.
or
Address
City lZip I Tela
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
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 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 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 ($500).
O 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.)
❑ 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.)
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 i1 the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. '
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant -Date-
Mailing
ateMailing Address
City, State, Zip
G�
BUILDING: TYPE CONST.
No.
OCC: GRP.:
A.P. Number
Legal Description ' row -t ?149' 5
Project Description
08655
0A 44
� -- 7LAi" " 1 ftiIFAC I" '46-iJ.20'r
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
. Issued by: Date Permit
Validated by:
Validation:
r
Sq. Ft.
Size 24QS
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
ti
Const.
7.q7 50
Mech.
fiQ
Electrical
120, Aft
Plumbing
ULM
S.M.I.
A
Grading
Driveway Enc.
Infrastructure
2872,68
Art In Ptihl in
R
TOTAL
"3$.2$ �r Yom_ ter.
REMARKS
0A 44
� -- 7LAi" " 1 ftiIFAC I" '46-iJ.20'r
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:
r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES .,
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
SLAB GRADE / G &u 5
YARD SPKLR SYSTEM q
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
STORAGE TANK
FORMS
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL S0. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REINF. STEEL
WAIER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
WATER SYSTEM
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SQ.FT.GAR ® 3/4c
HOUSE SEWER
FIREPLACE
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 1!, AIR COND. SOLAR
SETBACK�p
"EaHOUND PLUMBING l�'yJ
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE / G &u 5
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
'EWER QR Sri/
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF, j(� 240 �.
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
.
cuyd.
$ -plus-x$-=$
LUMBER GR.
NSP. 1/
FINAL INSP-111/,"A
Dl11111
FRAMING �l v
FINAL INSP.
ROOFING _
�AI� 7I�L bEGI\IAc j
( L 9
qr0 aAC
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
ING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Building
Address Al;—A24) 1
Owner
44
P.O. BOX 1504 �t�' 0 N o .
78-105 CALLE ESTADO ►�
LA QUINTA, CALIFORNIA 92253
Mailing
Address 859 H.., Mountain Aviv # 15TI
City IZIP ITel.
Cc
Address
Zip ITel.
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City I Zip I State
Lic. #
/,t#( LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that7l am licgnsed under provisions of Chapter 9 (commencing with Section
7000) of Division53 of the" Business a?tl Professions Code, and my license is in full force and
effect. �; W nA.r_ 4.1s
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
rireason: (Sec). 7031.5,Business and Professions Code: Any city or county which requires a
.permftto construct, alter, improve, demolish, or repair any structure, prior to its issuance also
14 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 ($500).
i' ❑ 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
iProfessions 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.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con -
1 • 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 havea 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
Q/FCopy.is filed with the city. ❑ Certified copy is hereby furnished.
jJ CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
I. (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 the 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.
i 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.
09270
B,U.ILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Legal Description T+�r+0—% t �a� 35 ot 16
Project Description
Sq. Ft.
.Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan-Chk. Bal.
2 AS.
Const.
A(�
Mech.
Electrical
FINAL DATE
Plumbing
This is a building permit when properly filled out, signed and validated, and is subject to
S.M.I.
.63
Grading
Driveway Enc.
I certify that I have read this application and state that theaboveinformation is.correct.
Infrastructure
193.25
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.
i
TOTAL
249 70 �
REMARKS
-
Mailing Address
I
t40S;faWilf#A 41 G I
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
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
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 theaboveinformation is.correct.
Issued by:
Date Permit
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.
Validated by:
` Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE V
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM t
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO. Ff.
OTHER APPJEOUIP.
REINF. STEEL
WALL SO. FT. ®
TEMP. POLE
DRINKING FOUNTAIN
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
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
I
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 ® 11/4 c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/.cHOUSE
SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
AELECT.FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE IPL.CK.FEE
CONST. FEE
SMI FEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING klf
/ UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE V
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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL