08650, 09272 (SFD)— r
rw
' P.O. 60X,1504 N o . 08650
Td4f Quibla
Building 78-105 CALLE ESTADO
Address 45-425 Desert Ele Cowt LA QUINTA, CALIFORNIA 92253
Owner
Mailing
$ BUILDING: TYPE CONST. OCC: GRP.
Address A4 W A= #1 _sn A.P. Number
City Zip Tel.
-15
i%land 91786 7141276-WS4 Legal Description Trim. -IP. 495 L o I
Contractor Project Description
am
Address
Q N w = Al
City Zip fief.
L#g&cltd 91796 7141276-9054
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size .2405 Stories Units
Designer Uume-v Johnann Areh., New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
.949
!`T
City Zip State
Bina Raton. FL 3W7 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 Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following 7
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, 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 PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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 Plan Chk. Dep.
subjects the applicant to a civil penally of not more than rive hundred dollars ($500). 58
.
ifl�
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. i 8
do the work, and the structure is riot intended or offered for sale. (Sec. 7044, Buisness and Const. '737450
. 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, •Meth. 60.00
AM
provided that such improvements are not intended or offered for sale. If, however, the building X60` 00
or improvement Is sold within one year of completion, the owner -builder will have the burden Electrical
of proving that he did not build or improve for the purpose of sale.) 129..bfll�
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 1". "0
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law Ei S
does not apply to an 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.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 287Z.68
Art in Public 69.19
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.
TOTAL "33.28 ux \t`^ 7
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or lel 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 ZONE: BY: '
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. '
Front Setback from Center Line
Rear Setback from Rear Prop. Line
1 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
Lend'er'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 the above information is correct. Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
i 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
IST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
SLAB GRADE /�v6.'�v �(�(�
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
'SEWER
DRAINAGE PIPING
CAR P. SQ. FT.
DUCTWORK
ROCKSTORAGE
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REINF. STEEL
WATER 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
LAUNDRYTRAY
AIR HANDLING UNIT CFM
a
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
VENTILATION
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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 /�v6.'�v �(�(�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
'SEWER
ROUGH WIRING
DUCTWORK
ROCKSTORAGE
FOUND. REINF. IL') -X" —qv A46-5
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
a
GRADING
yd.
LUMBER GR.
FINAL INSP. 3lcu.
FRAMING 4D
FINAL INSP.
1$-::---Plus—x$—=$
ROOFING —) ,dl/
o� (l
p n c
REMARKS:
VENTILATION
FIRE ZONE ROOFING4
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
JAI NG
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
P.O. BOX 1504 0. 09272.
Building 78-105 CALLE ESTADO L
Address tlS—A?c ih? aax9' F rig1,
qrMT1rj,,
LA QUINTA, CALIFORNIA 92253 f
Owner - jt
Address 1 unt . VA
City lZip ITel.
ty lZip
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm.that I am Ilcrnsed under provisions of Chapter 9 (commencing with Section
7000) of DivisiQvsof t `e Bu§iness and Professions Code, and my license is in full force and
6�
effect.%��i !r/�
SIGNATURE K,!<P 1.i "J DATE
j'' OWNER -BUILDER DECLARATION
T,-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
perm(t:ao construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicanV for,,sucMpermft 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
`lor.'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).
_0.1, 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.
I" CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed If the pe%mit is for one hundred dollars ($100) valuation
or less.)
I I certify that in the performance of thggwork 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.
z.
CONSTRUCTION LENDING AGENCY
Ihereby 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 Address
City, State, Zip
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
I Description I FYr'
Project Description
1.'A A x ,t
.r vel • �. .. �.n.wvs+r rr....+.
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
X"+up-,r) �-.ww,r. e►5..�'! en.u��►en�1.. �w�.v %i+er .wr .ai Q iL'A
.a....r7.....m........__
Estimated Valuation 6
PERMIT
AMOUNT
Plan 'Chk. Dep.
Plan Chk. Bal.
Const.
n
Mech.
+"''
Electrical
Plumbing
S.M.I.
.63
Grading
Driveway Enc.
Infrastructure
..
•. 9 W W C,.b
W r � �
TOTAL 164 7A
REMARKS
,;5:'fSh3 • ,�.1%3h,'�'. ,!-°� R�%Y }s(.t7'-,b:,,t'••A ''>GY . ! -i7 �yj
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
N0. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP. SQ. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
• DRINKING FOUNTAIN.
SO FT ®
WATER SYSTEM
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.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY.
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1Ya c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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
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 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL