09367 (SFD)0V
P.O. BOX 1504 Xv , No. 0936T
Building 78-105 CALLE ESTADO i t:
Address 79.305 Desert Rock Court. LA OUINTA, CALIFORNIA 92253,
Owner
GWR 33FVELO3PM _" T BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 45--305 Desert Eactl.e Court A.P. Number
City Zip Tel.
La Ouinta 92253 372-3336 Legal Description 239:5 Irt)nAT Php%to 11
Contractor Project Description Ln 21
ii .Cf t.F'!1f
.Address
City S AME Zip Tela
State Lic. City
& Classif. 35J��i Lic. # �61� Sq. Ft. No. No. Dw.
Size • . 2173' Stories Units
Arch.; Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thdf I am I1censed under provisions of Chapter 9 (commencing with Section
70 130) of Divisior1'X3 ofy.,the B/usiness d.Professions Code,. and my license is in full force and
ef act
SIGNATURE rtY11 t./�1, DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Secy 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 PERMIT .. AMOUNT
the provisions oI the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe 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 penalty of not more than five hundred dollars ($500). Plan Chk. Bal. ,0 1, as owner of the property, or my employees with wages as their sole compensation, will i
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.Professions Code: The Contractor's License Law does not apply to an owner of property who 7 211111 . On
builds or improves thereon and who does such work himself or through his own employees, Mech.
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 Electrical 1A
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- Plumbing
strucl 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 S.M.I. y�
such projects with a contractors) 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 ? 5R
10 is
� 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
Copy is filed with the city. ❑ Certified copy is hereby furnished.
i TOTAL AASQ 19
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE `
70
(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 thg work for which this permit is issued, I shall not
employ any peon in any manner so as to become subject to the Workers' Compensation
Laws of Cal ifornirsa.
Date Owner
I 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
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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
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
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SO. FT.
SLAB GRADE
YARD SPKLR SYSTEM
ROUGH PLUMB.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
STORAGE TANK
FORMS AV
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SD. FT.
GAS (ROUGH) i 3 A ILx,
I LLLL L
WALL SO. FT.
DRINKING FOUNTAIN
SQ FT ®
REINF. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
TEMP. POLE
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
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
LUMBER GR.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
SPARK ARRESTOR
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
SETBACKGROUND
PLUMBING
DERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS AV
igSEWER OR SEPTIC TANK0,
Gfi-wH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) i 3 A ILx,
I LLLL L
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. ®a Rl(�
FRAMING `
FINAL INSP. O
ROOFING S�
(C.
L10
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING t ,n LL!/
MESH
INSULATION/SOUND P
FINISH GRADING
FINAL INSPECTION C11
IL
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL