05886 (SFD)4
4
a P.O. BOX 1504 N o . 05886
Building44-373 Vil&OW Circle 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
owner *.
Mailing .r
Address43_875 W&ShIngton St.
City La Zip 92253 Tel.
Contractor
Address.
3Lrlillf:' `
City lZip I Tel. .
State Lic.I City
.—& Classi.—.• Lic. #
moron., tngr., .
Designer
Address Tel.
City( Zip I
State
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. t
t �
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
"Irhereby iffirjm that 1 am exempt from the Contractors License Law for the following
reason: fSac. 7031.5,Busmmmess 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 pemmft to file a signed statement that he is licensed pursuant to
the provisions of the Canbactor§ license Law, Chapter 9 (commencing with Section 7000) of
A 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 cM penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
• � - do ilia work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
--Professions Code: The Contractors License Law does not apply to an owner of property who
.,builds or improves theree"n and who does such work himself or through his own employees,
t3piovided that such Improvements are of intended or offered for sale. If, however, the bullding
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he, did not build or enprove for the purpose of sale.)
❑ 1, 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 contacts 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
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. mpany
O Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need of be completed ff 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: If, after makig 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 shag 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.)
Lenders Name
Lenders Address
This is abuilding permit when property 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 Fh88e Yl LOt 56
Project Description PUn X Cactus Flower
REMARKS
lvY4 J "zav 11;/4-ijc.•j`C4W,1i..:i7'-4�JR: f'9.:1.v
ZONE:
BY:
-Minimum Setback
Distances:
Sq_Ft. 1633
Size
No. No. Dw.
Stories -Units
New (Z Add ❑
Alter ❑ Repair O Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Estimated Valuation
861825.06
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bat.
480.03
Const.
581.t3o
Mech.;3
Stn
Electrical
34.4
Plumbing
�` •�
S.M.I.
�..
Grading
Driveway Enc.
Infrastructure
1953.56
w
TOTAL
3.4279.
REMARKS
lvY4 J "zav 11;/4-ijc.•j`C4W,1i..:i7'-4�JR: f'9.:1.v
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. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL) r; f ��
MP. POLE
WALL SO. FT. ®
DRINKING FOUNTAIN
SOFT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING �C
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,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 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
MESH
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 I ELECTRICAL HEATING & AIR COND. 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. 1 (,
GAS (ROUGH) (// Z7�j�s�71,Mri
111
ER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) r; f ��
MP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
�
FINAL INSP. �� 7!/
FRAMING ( ( /
FINAL INSP.
ROOFING �C
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
9e;11,07 111*7
LATHING44 2
MESH
jr-
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINRIALS
'
GARDEN WALL FINAL