06916 (SFD)P.O. BOX 1504 N Q . 06916
Building 49-440.Via PoMa 78-105 CALLE ESTADO
LA QUIN IA, CALIFORNIA 92253
Owner
0 BARC03 DEVELOPROT
Mailing
Address %W_713 Perez Road.
City Cathedral Ci t PP 92234 JTJ 773--9024
Contractor ;lMIC.
city
State Lic. 337077Icityl
12
Lic.
& Classif.
Arch., Engr.,
DesignefM
Address Tel.
City Zip State
Lic. #
-OCENSED CONTRACTOR'S DECLARATION
I hereby affirm that- I am licensed under -provisions of Chapter 9 (commencing,with Section
7000) t.of Division 3 ofithe.susiness and Professions Code, and my license is.in,full force and
effec:. a- / ✓ /ms�ss
S_ GNATURE DATE
OWNER -BUILDER DECLARATION
I heretiy affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.8useresss and Professions Cede:. Any COY 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 permit to Me a signed statement that he is licensed pursuant to
the 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 exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars (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
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 hxnsuyf or through his own employees,
provided that' such improvements are not intended or offered for safe. it, however, the building
or improvement is sold wilfth one year of completion, the owner -budder will have the burden
of proving that he did not build or improve 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 braids or improves thereon, and who contracts for
such projects with a contractor fs) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec_ a- S 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
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 fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the pend is for one Modred 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
aliforniaDateOwner
NOT/CE TO APPLICANT: If, after making Qmis Certificate of Exemption you should become
subject to the Workers' Corrpensatian provisions of the Labor Code, you must forthwith
comply with such Provisions or this pend 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.)
Lender's Name
Lender's Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 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 Tract #21555-4. Phase iii
Legal Description
Project Description
Plar,
fit{
P L QUINTA
2222 (D), Lot #15
Sq. Ft. 2,222
Size
No. No. Dw.
Stories Units
New' Add"D
Alter 0 Repair 0
Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
55071.10
Const.
685.00
Mech.
60.00
Electrical
120.79
Plumbing
144.50
S.M.I.
7.91
Grading
Driveway Enc.
Infrastructure
2.523.63.
r
TOTAL
4, 1' 2.9'3 , ��
REMARKS
^C1Ar r F x- a ts� _ ..rld4 :A
hF'
jc � — -. V 3 - b 17; ¢�
9 ,y
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
A.C. UNIT
2ND FL SO. FT.
SLAB GRADE
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
SEWER OR SEPTIC TANK
DRAINAGE PIPING
WALL SO. Ff.
DUCT WORK
DRINKING FOUNTAIN.
SO FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
TEMP. POLE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
WATER HEATER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
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. Ff. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/a'c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
TNST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBING//g
.e&VVDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
73OUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) Sid Q
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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.
FRAMING
FINAL INSP. /AA
ROOFING
'� � �^
.y1 � �J
2 LVA
�JG�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
ATN -2m
MESH
INSULATIONISOUND l ZV
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL