05896 (SFD)Building
Address
Owner
Mailing
Address
,:.;City
Contractor
Address
I T4tyl 4 4 Q"
"-4N Willow Circle
La i ca Associates
4.3-875 Washington St.
Zip Tel
P.D. 92260
is.. S.
State Lic.5�1�
& Classif.
Arch., Engr.,
Designer
Address
Tela
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST
+ y
Lic.' # 1231
City y (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
700
0
) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. '
SIGNATURE DATE
r OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.Bushess and Professions Code: Any city or county which requires a
pemil to construct, alter, irprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to We a signed statement that he is licensed pursuant to
.Ne provisions of the Contractors 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 exerrption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civi penalty of not more than rive hundred dollars (S500).
❑ 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, 0uisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves (hereon and who does such work himself or through his own employees,
Provided Nat such irprovements are not intended or offered for sale. It, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did net buil of irprove for the purpose of sale.)
O 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 contracts for
such projects with a contractors) 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
Workers 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 conplated If the permit is for one hundred dollars (8100) 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_ 9, after makeng this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you. -must forthwith
comply with such Provisions of 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.)
Lenders Name
Lenders Address
. This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. '
I certity 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
No. 0;5896
OCC: GRP.
A.P..Number .
Legal Description s Ii Lot 54
Project Description Pl 2A. Cactnim Flower
err
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft.I�1
Size .•
No. No. Dw.
Stories Units
NewyD Add ❑
Alter ❑ Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback frcan Property Line
FINAL DATE
INSPECTOR
Issued by:
—DatePermit
Validated by:
Estimated Valuation
%a51".Q0
PERMIT "-
AMOUNT
Plan Chk:,\Dep.
Plan Chk. Bal.
$ +
Const.
Mech.
Q
Electrical
104.00-
c0 . 0Plumbing
Plumbing
X23.00
S.M.I.
6.16`
Grading
Driveway Enc.
Infrastructures•
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 frcan Property Line
FINAL DATE
INSPECTOR
Issued by:
—DatePermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
SLAB GRADEr�
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL S0. FT.
FORMS j
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH) Iv q/�
ETER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) Z
6B101P. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
FINAL INSP.
URINAL
SO FT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
ROOFING
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(AUTO)(DISH)
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. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR C VAc
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE TLUMB. FEE
STRUCTURE PLUMBINGELECTRICAL HEATING & AIR COND. SOLAR
% ice"
SETBACK
GROUND PLUMBINPP'f
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEr�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS j
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. -7604g.7.4"
GAS (ROUGH) Iv q/�
ETER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) Z
6B101P. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
-CU. yd.
$ plus x$
=$
LUMBER GR.
FRAMING ZO
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING ,y
MESH
INSULATIOWSOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL