06917 (SFD)P.O. BOX 1504 -
Building 49-0-0 via Pwpa 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
RCON CEVELOP140T
Address 68-713 Perez Road, #1
CityCattiedral Cl YPP 92234 ITeV73-9024
Contractor
City lZip
State Lic. 337077 ( City 1219
& Classif. Lic. #
Arch., Engr.,
Designer
I Tel.
City IZipI State I
Lic. #
LICENSED CONTRACTOR'S OECLARATIONf-
I hereby affirm that 1 am licensed under'provisions of Chapter 9 (commencing wi
Nof:Divi'siin'3 of the Business and -Professions Code, and my license is.in full
OWNEWBUILDER DECLARATION
I hereby affirin that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Ls 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 permit to We a signed statement that he is licensed pursuant to
the provisions of the Conbactoes 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 chd penally of riot more than five 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 Contradors License Law does not apply to an owner of property who
builds or improves thereon amid who does such work himself or through his own employees;
provided that' such inprovements are not intended. or offered for sale. It, however, the building
orimprovement is sold withinone year of completion, the owner -builder will have the burden
of proving that he did not braid or -reprove 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 contracts for
such projects with a contiaaor(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
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. 3800, Labor Code.)
Policy No Company
E) Copy is filed with time city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if 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: ff, after making this Certificate or Exemption you should become
subject to the workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or 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
Lender's Address
This is a building permit when properly 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. 06917
BUILDING: TYPE CONST. OCC: GRP.
Tract #21555-4g Phase IV
,A.P. Number
,Legal Description
PARC LA QUINTA
Project Description
Plalf, 2004 (C). Leat #17
2,004
Sq. Ft. No. No. Dw.
Size Stories . Units
New EX Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
51023,02
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal..
545.95
Const.
�.
Mech.
7.3.00
Electrical
113.30
Plumbing
138.50
S.M.I.
7.21
Grading
Driveway Enc.
Infrastructure,2.�.�J
TOTAL
3s8L3.
REMARKS
.1.�441.,7i 4`r.�.7>•'i''� :t.-'t�"LYi y�1;,x �.. cd f.-,ri. ��i .1 ..:
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
PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
r
POR. SQ. Ff. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. Fr. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. Fr. ®
GAS (ROUGH)
DRINKING FOUNTAIN.
SO Fr. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V/ac
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. y -t jo
��LL
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
o
FINAL INSP. it
v
FRAMING
FINAL INSP. �aC..[/
[
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION O O
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL