06842 (SFD)ce,ity�, 4
Building 44.215 Goldenrod Circle
Address
Owner
La Quiota Associates
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address 43-875 Washington St.
City Zip Tel.
Palm €user 92260 1
345-1541.
E.G. Williams Dev. Coif•.
Address Same
State Lic. City
& Classif. 49391.9 Lic. # 1231
Arch., Engr.,
Designer
Address Tel.
City IZip I State I
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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buskiess and Professions Code: Any city or county which requires a
permit to constrict, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Ile a signed statement that he is licensed pursuant to
the proviskm of the Contractor's 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 exerrloWn. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a cinipenally 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 the 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 thereon and who does such work hanself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold wdhxu one year of completion, the owner -builder will have the burden
of proving that he did not bwV Of improve for the purpose of sale.)
0 I, 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 inproves thereon, and who contracts for
such projects with a contrac(ors) icensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec a.-&'P.C. for this reason
Owner v �t r ;> P14 4...,..
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
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed fl 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
alifornia-
DateOwner
NOTICE TO APPLICANT: tl 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.
No. 06842
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number Tract 22982 a Phase IV
Legal Description Cactus Flower
Project Description Plan 58R - Lot 4106
Sq. Ft. 2134
Size •
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
4113,413
PERMIT
AMOUNT
Plan Chk. Dep.
t; Q9
Plan Chk. Bal.
-
Q.5.2
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
-441
�1 Cs '
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lenders Name
Lenders Address
This is a building FINAL DATE ISPCTOVpermit when property filled out, signed and validated, and is subject to T �T
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. Issued by: Date Permit
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 _ Validated by:
Signature of applicant Date'
Mailing Address Validation:
City,. State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
DUCT WORK
ROCK STORAGE
FOUND. REINF. �S r®�%
S
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. I SQ. FT. ®
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
WALL SQ. FT. ®
LUMBER GR. FINAL INSP. cLdG
DRINKING FOUNTAIN
SO FT ®
J/� /sy00,�
'^
V �l S S -212-)1-26 v
URINAL
ESTIMATED CONSTRUCTION VALUATION $
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(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® Vhc
HOUSE SEWER
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 S AIR COND. SOLAR
SETBACK
GROUND PLUMBIN NDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADES 9
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
It
SEWER OR SEP17C TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. �S r®�%
S
GAS (ROUGH) -?/ -�d 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.
$ plus x$
=$
LUMBER GR. FINAL INSP. cLdG
FRAMING FINAL INSP.712-?1?6 L
ROOFING ! ✓
VENTILATION
FIRE ZONE ROOFING��{
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING ara,l O
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION /
CERT. OCC. C
ccurc ciMAI
J/� /sy00,�
'^
V �l S S -212-)1-26 v
REMARKS:
SIGNATURESIINITIALS
GARDEN WALL FINAL