05895 (SFD)P.O. BOX 1504 No. 05895
Building 44-3� Willow Circle 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner k
La, QLtiata Associate: _
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address .43-875 Washington St. � A.P.,Number
CityZip Tel.
-P.D.,322,6J Legal Description Phase Il Lot 51
Contractor n Project Description Plan 2A 'bus Floye3*
E.G. William u-7. Corp. e .. t e, ._ ... _
Address
Sam r
City lZip Tel.
State Lic. : City
& Classif. 493919 Lic. # 1231, _
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTORS DECLARATION
-J hereby -affirm that 1 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- E
_SIGNATURE i DATE
"w
OWNER -BUILDER DECLAMATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Buskhm and RWessions Gide: Any ray or county which regldres a
permit to constnat:.after. improve. demolish. or repai arty structure. prior to gs issuance also
requires the applicant for such permit to tie a signed statement flit hes licensed pursuant to
the provisions o/ the Contractors. License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Prufesskims Code, or 9a. he Is exempt therefrom, and the basis
for the aDeged exemption. Any violation of Section 7031.5 by arty applicant for a permit
subjects the applicant to a civil penally of not more than five hurxh.M daftrs (5500).
❑ 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
Prolessfons Code: The Contractors .License Law does not appy to an owner of property who
builds or improves thereon and who does such work hirse9 or fhrough his own employees,
provided that such improvements are not intended or offered for sale. 9, however, the bmidmg
or improvement is sok/ within are year of completion, the owner4halder wil have the burden
of proving that he did not build or improve for the purpose of sate.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Prafessions Code: The Contractors License Law
does not appy to an owner of property who bulls or irprores thereon, and who contracts for
such Projects with a contractor fs) licensed pursuant to the Contractors License Law.) .
❑ 1 am exempt under Sec— ------& g P -C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3000, Labor Code.)
Policy No Company
O -Copy is filed with the city. O Certified copy is hereby famished.
CERTIFICATE OF EOIEMPTION FROM
WORKERS COMPENSATION INSURANCE
(This section need not be completed 9 the permit is for one Aurdred dollars ($100) valuation
or less.)-" .
1 certify that in the performance of the work for which this permit is issued, I shall not
employ any
Laws of California person in any manner So as to become subject to the Workers' Compensation
Date ,Owner
NOTICE TO APPLICANT: ll, after making 9nis CerhScate of Fierrptiwn you should become
surbject to fire Workers' Conpersation provsivs of the Labor Code. you must forthwith
comply with such Provisions or this permit stag 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, Civ@ Code_)
Lenders Name
Lenders Address
This is a building permit when properly fulled ouR 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. Abd; . No. No. Dw.
Size Stories- Units
News) Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation 87,514.00
PERMIT
AMOUNT
Plan Chk. Dep.
Distances:
Plan Chk. Bal.
at5t3...
Const..
liar "J
Mech.
�•�^
Electrical
•
Plumbing
•
S.M.I.
at t
Grading
Issued by -Date
Driveway Enc.
I i
Infrastructure
y"
Validation:
TOTAL
3330,00,..--f Cw i}.•'
REMARKS<1➢Ri.e*x3i}
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. a $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
Y
ARD SPKLR SYSTEM
2ND FL. SQ. FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. $Q_ FT. a
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. a
EMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. a
FINAL INSP.
WALL SQ. FT. a
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
y plus xi
=S
URINAL
SQ FT a
ROOFING ( 7� a�Q
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATH ING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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. a c
BATH TUB
SQ. FT. a c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID a 1+/. c
SEWAGE DISPOSAL
SO.FT.GAR a 3/ic
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 PLUMBI.N 4 /)a ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING e
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. 16
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
EMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
y plus xi
=S
LUMBER GR. FINAL INSP. q QOOV D
FRAMI G� r( l �(� FINAL INSP.
ROOFING ( 7� a�Q
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATH ING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
REMARKS:
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL