08649 (SFD)A) I ,
44a
45-455 Dowart Co=t P.O. BOX 1504 No. 00649
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253 ..
GWR DeV@lopment.
Mailing
Address 8591 N. N;mtaist &Vrnm #25u
City Zip JTeL
Contractor
H. Nallimt4du Avf>xt m #15$
Zip I Tela
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer QUIMY JQlm$Ofl Arch*
Address I Tel.
City P Zi State
it~* Rat= - EL I TUA7 I 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
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 o/ 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
!or the alleged. -.exemption: -Any -violation, o/ Section 7031.5 -Dy 'any applicant !or a permit
sub%ects.fhe_'aliplicant toga Civfl Penaltyol notmor.'e thanrfive hundred dollars -($500).
`I; as ownerof, 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 Lfcense Law does not apply to an owner o/ property who
builds;Oi..Improves`-'thereon 'and who does such work himsell or through his own employees,
provided that. such improvements are not intended or o/lered /or sale. I/, however, the building
or improvement is sold within one year o/ 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
O 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
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.
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 Address
City, State, Zip
BUILDING: TYPE CONST
OCC: GRP.
A.P. Number
Legal Description Trowt 23935 1 reaanr.
Description
Sq. Ft. No.' No. Dw.
Size 2173 Stories Units:
New ❑ Add ❑ ' '--Alter ❑ Repair ❑ Demolition ❑.
imated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
Art In Pubfe
TOTAL
REMARKS
AMOUNT
720.00
60.00
M-11111
139.!50
RAI
27513.22
:s> —IA7
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
a..
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. SQ. FT. ® $
UNITS
SLAB GRADE �_5_ )6 G
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM r
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. S0. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPIEQUIP.
DRAINAGE PIPING
CAR P. SD. FT.
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SO. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WAiER PIPING
NOTE: Not to be used as property tax valuation
_$
FLOOR DRAIN
MECHANICAL FEES
FRAMING CCI�i Lp
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/e c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
INSULATION/SOUND - tq(_I L
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 & AlR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE �_5_ )6 G
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
v
tgEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. �O �'Y JCJ �(�
GAS (ROUGH) 3 ��^ (
METER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
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 CCI�i Lp
n
FINAL INSP. r .�/
ROOFING � i / CD
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
HING KzOct ( c U
MESH
INSULATION/SOUND - tq(_I L
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIAIS
GARDEN WALL FINAL