06564 (AR)-.78- 239 Hacienda
Owner
a. La Quints Rameomer
City
Contractor
Edg&r• Cmettuction
40-825 -025 Yucca Lane
Zip
i hAMiAt
4 4 Q'4
P.O. BOX 1504
7&105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
i'& ss if 357278 6 3
Arch., Engr.;
Designer
Address- _ Tel.
City ,.:: Zip State
Lic. #
LICENSED CONTRACfOWS DECIARATWN
I hefebv-affirm.that l am llcensed under provisions of Chapter 9 (commencing with Section
7000) of %,-,sign 3 Of the Busbvasa., W PrOhnshm Code, and my license is! In full force and
ZOGNATURE DATE
O W N ER-BUILDERDECLARATION
I hereby affirm -that I am exempt: from the Contractors License. Law for the following
reason: (Sec. 7031:5,flarsireas"and_Prdesefores Cade: Any city or -county which requires a
permit to construct. atter, brwm* 1 0 b or r.psh any structure,prior to ,tta lsauerrce also.
requires the appdkarrt for such. Pam* to fda a that he, is. Bcarreed pursuant -to
the.pLicense
roe'l`mns of me Conbacto►tr •Lamm CLpptw 9 (oonmrenchm irffh•Seutbn 7000) o1
OYvfsfon 3 of the Sushoss.,arM Pio/esNona: Code d drat. he A exempt. thme/rom. and the basis,
for the,-ette9ad exemprlarl. Any_ vfokllon at Seceion 7037.5 by any applicant (ora permtt
strb(eds Ilea applicant to a &VU peuaQy-orrw more mail five hundred dollars, ($500)..
❑ 1, as owner of the property, or;,my'amployees,with wages as their sole compensation, will
do the work, and the structure is not irdended,or offered for sale_ (Sec. 7044, 0udaness and
Aofessbas Code: The Caubactarb License Law dam not.ap* loan owner•of property who..
builds or srrproves thereon and who dues suchworry hderseff or through_ .his .own. employees.
prodded that.such inprovements are not kdafler
rdad or'oed for s&W. N,, however: the bulld4tg.
or bnprovement is solid within one yam o/ uaonp/etion, the owner-bullder wffl have the twrden
of prorbrg that he did not build or ft"ve for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting wiM:licensed,contractors to con-
struct the project- (Sec. T7044. Bust ass and Profassbns;Code., The Cordractors Lkense Laciv
does not apply to an owner of property who builds or ftwoves thereon, _and who contracts' for
such prq is Mrh a contractors) licensed pursuard to the Contrectork License Law:)
❑ 1 am exempt under Sea w a P.C. for this reason
Date - Owner
WORKERS' COMPENSATION DECLARATION
I hereby -affirm that I have a oertificats of consent to self4risure, or a certificate of
Workers compensation Insurance; or a certifled copy thereof- (Sec. 3800; Labor"Code.)
Policy No Companiy
❑ Copy is flied with the city. 0 Certified copy is hereby:furolshed.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION. INSURANCE
(huts sectionneed' not be corrmfeted A the panic is for •me hundred da0am ($100) v&wtbn
oass.)
. • lL I certify, that in the performance of the>work for which this permft is issued, I shall not
employ artyi o'person in any mannerso as to become'subject to the Workers' Compensation
Laws of colf iia
Da te pruner
NOTICE >D APPLlCAM. Jr. after rrre-119 this Cwgft to of Exempben you should become
stdoct to the Workers' Conipansatim prorfsons of the Labor Code, you must forthwith
comply with suchen provisions or this permit shaft 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;. CW Cods.)
Lenders Name
Lender's Address
This is abuilding permit when properly filled out; signed and validated, and is subject to
expiration ff work thereunder fs.suspended for 180 days
I certify that.l have read this application and state that. the above information -is correct.
I agree`to comply with all olty•and eounty'ofdirmances end state laws relaGng.to building .
construction; 'and hereby authu % mpnisoinmWes of this city to enter the, above-.
mentioned property for Irmapecflon purpceea
Signature of'applicant Date
Mailing Address—
City,..Stat% Zin
No. 06564
WILDING: TYPE CONST. - OCC: GRP.
\:P: Number Calf Club Estates
.egal Description
'rojectDescription mthl raam addition
ZONE:
BY:
Minimum Setback Distances:
Sq: Ft:
Size '
No.
Stories
No. Dw.
Units
New 0 Add O
Alter ❑
Repair ❑ -Demolition ❑
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
Estimated' Valuation
$3 a gtlC
PERMIT
AMOUNT
Plan, Chk. Dep.
Plan Chk. Bal.
$ S
Const:
3..0
Mech.
Electrical
15.00
Plumbing
22i.00
S.M.F.
. ZQ
Grading
Driveway Enc.
Infrastructure
TOTAL
i.a'
it `! ) -
REMARKS
.,..
ZONE:
BY:
Minimum Setback Distances:
Front.Setbackrfrom 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
IST FL SO. FT. a $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR.SYSTEM
2ND FL SO. FT. 0
FORMS
SEWER'OR.SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. W. FT: ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP.,POLE
DRAINAGE PIPING
CARP. SO. FT. ®
GROUT
WATER HEATER
WALL SO: FT- @
FINAL INSP.
DRINKING FOUNTAIN.
SO ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO►(L)ISH)
APPLIANCE DRYER
GARBAGEOISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING -
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USEPERMIT 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
LATHING
SO. FT. ® c
WATER HEATER
MAX: HEATER OUTPUT, B.T.U.
SO. Fr. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR 0 3Ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK:FEE
CONST. FEE ELECT. FEE
SMIFEE 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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP.,POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
y -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS
VENTILATION
FIRE ZONE ROOFING -
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC,
FENCE FINAL -
INSPECTOR'S SIGNATURESnNITIALS,
GARDEN WALL. FINAL