06918T4ht 4 4 Q"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 49-400 Via Pollit m LA QUINTA, CALIFORNIA 92253
Owner
Address 68-713 Perez Road, #1
CItyCathedral City Zlp 92234 Te173-9024
Contractor
city
State Lic. 337077I City 1219
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
Cityip (State
(Z
!� Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
700D) of Division 3/of the Business and Professions Code, and my license is in full fore and
effect�l�t/�
SIGNATURE / ti ° DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busness 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 appicant for such permit to lie a signed statement that he is licensed pursuant to
the provisions of the Contractor's license Law, Chapter 9 (commencing with Section 7000) of
Diviston 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the afeged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenally of not more than rive hundred dollars ($500).
❑ 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
dards IILL Ireproves thereon and who does such work hinself or through his own employees,
providA that such knprovements 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 orrrprove 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 buBds or inproves 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
I hereby affirm that 1 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be comI*ted if the pemvt is for one hundred dollars (5100) 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: ff. 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 shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
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 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
No. 06918
iBUILDING: TYPE CONST. OCC. GRP.
A.P. Number Tract #21555-4, Phase IV
,Legal Description
Project Description PARC U1 QUINTA
Plan 2222 {0}, Lot #18
Sq. Ft. 2,222 No. No. Dw.
Size Stories Units
New EX Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $112,151
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
b iJ
Const.
bb
Mech.
bu.tlii
Electrical{.
IV
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
s
REMARKS
- 1
AVr - [.nab, 1 5._,mli
•nom .• .
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback frcm Property Line
FINAL DATE NSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL S0. FT.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
SEWER OR SEPTIC TANK
ROUGH WIRING,
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. SO. FT. ®
HEATING (FINAL)
WALL Sp. FT.
REINF. STEEL
DRINKING FOUNTAIN.
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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
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.
GAS (ROUGH)
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.
ts -plus-x$-=$
LUMBER GR.
FINAL INSP. `7 �vC
FRAMING
FINAL INSP.�Z,Q Oaz
ROOFING
r
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL