002967 (AR)P.O.. BOX 1504 No. 002967
78-105 CALLE ESTADO
,LA OUINTA, CALIFORNIA 92253
' Owner
Mailing
Address 700 KWt Lee
City Zip
Contractor
44-163 Acezda Drive
City - " Zip Tel.
State Lic•I City
& Classif. B 264-394. Lic. #
Arch., Engr.,
Desianer
JILDING: TYPE CONST_. OCC. GRP..
P. Number
igal Description
oject Description 323 ;DZoFtd &t1m -
Sq. Ft. No. No. Dw..
Size Stories Units
.New El Add= • Alter ❑ Repair 0 _
Demolition 0,
Address Tel.
City Zip State.
_ .. Lic. #
LICENSED CONTRACTOR'S -DECLARATION _
I hereby affirm that I am -licensed under Provlslone 4 Chapt�T'9"(commencing with Section
7000) of Divislon.3 ofaheBusineas andiProfesslORsr.Code and my license is in full force and
affect.
fc 1'i-
- �t ' HATE . .. - .
OWNER•B LDE
IR DECLARATION
I hereby, affirm that 1,am,exempt from the Contractor's License Law for the following Estimated Valuation.
_ reason: .(Sec.. 7031.5,Buslness_and Professions Code: Any cily,.or county which requires a �3
pemift to construct, ager, Improve, demolish, or'rapair any structure, prior to Its Issuance also - ; ••7
• requires the applicant_ for.. such permit .to me �a signed statement -that-he Is, licensed pursuant tp PERMIT - _ AMOUNT - -
the provisions of :the Contractor's- License Law, Chapter 9 (commencfhg wlth Seet(on 7000) of -
'Olvlsbn'3 of the Business and'Professlons Code, or°that. he Is exempt therefrom, and'the basis: - -
.for the alleged exemption. Any vfo,lation of Section 7031.5 by any applicant for -a. permit Plan Chk. Dep.
subjects the applicant to a c_, en yo, not more -than Rve.hundred dollars (5500).
-
Chk. .
• Bal
Plan � � �-►
• D I as ovvnerof the property, or_my employees with wages as heir sole compensation, will
doahe'wdrk, and the•structure is not intended or offered for sale. (Sec. 7044,.Buisness and
Professions Code: The Contractor's License Low.does_not applyto,en�ownsr of property who
Const.- - -
builds or Improves thereon and who does such work himseff of through his own employees,
Mech. '- IN
_ provided' that such improvements are not Intended of offered for sale: If, however, the building
or Improvement is sold wthin one year 'of completion,' the owner -builder will have the burden
Electrical' ••
of proving that he did not build, or improve for the purpose of sale.) : _ .. -
❑ I, as owner of the property, am.exclusively,contracting with.licensed contractors to coo-
Plumbing 21 eM
-struct the project: (Sec. 704.4; 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
$.M.I:
• such projectswitha contractor(s) licensed: pursuant to the Contractor's License Law.) -
Date Permit
Validated by:
Grading
0em exempt ,under Sec. B. 8 P.C. for this reason
_
Driveway Enc.
Date - Owner.
Infrastructure
WORKERS' COMPENSATION DECLARATION
1 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. A- 'r Company.
❑ Copy is filed with the;city: 0. Certified copy is herebyfurnished.
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, nshall not
employ any- erson in any manner so as to become. -subject -to the•Workers' Compensation
Laws of California.
-Date Owner
NOTICE TO APPLICANT If, after making this Certificate of Exemption you should become
subject to the Workers' Cornpensallon"provisions- of the Labor Code; -you must forthwith
comply wfm such provisionsorthis permit shall be deemedrevoked. -
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 properly filled out, signed and validated, and is.su-bject to
expiration if work thereunder is suspended for 180 days.
1 certifythat,l 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.forInspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
TOTAL
REMARKS.
ZONE:
BY:'
Minimum Setback Distancesi
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.
A743b
3 5 s4b.54. R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL SD. FT.
ROUGH PLUMB.
YARD SPKLR SNSTEM
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
SEWER OR SEPTIC TANK
ROUGH WIRING
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CARP. SO. FT. ®
HEATING (FINAL)
OTHER APP./EQUIP.
WALL SQ. FT.
GAS (FINAL)
DRINKING FOUNTAIN
SQ, FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be:used as property tax valuation
FINAL INSP.
FLOOR, DRAIN
MECHANICAL FEES _
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
✓/If ;7
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.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR @ 3V.c
HOUSE SEWER
LATHING
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 I PLUMBING ELECTRICAL HEATING & AIR GOND. 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 APP./EQUIP.
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 3 /3
FINAL INSP.
ROOFING
✓/If ;7
�` 9
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
N LATION/SOUND 3
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
S0800L FACILITY FEES
TO: City of ;La 'QuInta DATE::
Department of Community Development
78-105 Calle Estado
La Quin.ta, CA 92253
This is to cer,t.ify tjtat���
developer of which is
located at e-� ��� within.
this District, has paid..school facility fees imposed pursuant to the
authority .genera: a by G vernment Co a Se tint 53080 in t amount of
covering, a total of squ a feet of ( residential or
( ) industrial/commercial development and that building; permits :for
this footage in this development may now tie issued by your ju'r sd ;ct,i.
for.DESERT'SANDS UNI ED SCHOOL DISTRICT
00 SL
- Building Department * Yellow . Facilities Planning .0 Pink - Accounting • Gold Developer
00 co 4 S• 7L
(1,0)-37