09365 (SFD)Building
Address
Owner
Mailing
Address 45-305 Des
City I Zip
Contractor
Tel.
414 a t,
P.O. BOX 1504 r N o .
78-105 CALLE ESTADO i
LA QUINTA, CALIFORNIA 92253
4f
11LDING: TYPE CONST. ----.-----OCC: GRP.:
P. Number
09365
—333" Legal Description Tlr^ct 23935 Topaz Phaitn TT
Project Description Id?t 28
Address
9-4 AMR
City Zip Tela
State Lic. City
& Classif. 535557 H Lic. # 1535
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
� LICENSED CONTRACTOR'S DECLARATION
I hereby affixmthat I ani,{licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of tKii Business and Professions Code, and my license is in full force and
effect..f► I • . _ 1}�
I 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.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION t
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.
IJJ� 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 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
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
Sq. Ft.
Size
New ❑
No.
- Stories
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bala
Const.
Mech.
110 • WU
Electrical
60.00
Plumbing
129.6
S.M.I.
'4 V. SO
Grading
• 1
Driveway Enc.
Infrastructure
T. In InO. 11C � • YJ
•F
TOTAL
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_
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
_. T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL. SO. FT.
SLAB GRADE
YARD SPKLR SYSTEM
POR SO FT ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT.
L p SEWER OR SEPTIC TAN
DRAINAGE PIPING
WALL SQ. FT.
DUCT WORK
DRINKING FOUNTAIN.
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
METER LOOP
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER HEATER
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, 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 ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ec
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 IQ
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
-"?II
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS Ott
L p SEWER OR SEPTIC TAN
l�
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) % /t 3(a I
a
L
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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. t (�
FRAMING L®
FINAL INSP.
ROOFING (110 �
L�
� �
N
/' /��y
� � ,^
REMARKS:
Sib IDk4,r
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
,n
HING $ L
MESH
INSULATIONISOUND 7 2
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL