002924 (AR)Address 46-400 VkZ3-S P&Vk Foado 05
Owner
Mailing
Address 4&.400 DyMpaXkP >r5
City Zip Te'
. Le. lQuinta 1 92253 1-
Cantrartc)r
3-
4
4
P.O. BOX 1504 No. 002924
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA.92253
S & J m- Fel W.
Address
CityZip Tel
ld� lima 917512 714) 685-3330
State Lic. City
& Classif. 275514 C61 Lic. #
Arch.; Engr.,
Designer
Address I Tel.
City Zip State
Lic. # . .
LICENSED CONTRACTOR'S DECLARATION
I hereby.affirm-that I am licensed under provisions of Chapter 9,(commencing with, Section
70(x1) of Dlvision 3 of the Bdsiness and Professions Code, and my license Iain full force and
effect: ` "/
SIGNATURE _' ""� - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt -from the Contractor's License Law fonthe following
reason: (Sec. 7031.5,Buslness and, Professions Code: Any city or counly- which requires a.
permit to construct, attar, Improve,, da n dish, or repair any structure, prior to its. issuance also
requires the app/kant for such permit to file a signed statement that he4a licensed punivant'to
the provisions of the Contractor's. License Law, Chapter 9(commencing with Section 7000) of
- Division 3 of the Business and Piotessiona Code, or than he ''is exempt therefrom,and the basis.'
for the alleged exemptlW. Any 'violation of Section 7031.5 ,by 'any. applicant for . a permit
subjects the applicanbto a civil pena/ry-of not than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as theirsole compensation,.will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner. -of property who
builds or Improves thereon and who doessuch work himself or through his own employees,
provided that such Improvements are. not Intended' or., offered for sale. ff, however, the building
or improvement Is sold within one year of completion, the -owner-builder will have the burden
of provinp.that he did not buUd.or improve forthepurpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec.• 7044, Business and Professions.Code: The Contractor's License Law
does not "apply to an owner of property who builds or improves .thereon, and who contracts for
such projects with a confractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. 1. P.C.-for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
I hereby, affirm that 9 have a -certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance; of a'certified copy thereof. (Sec. 3800, Labor Code.)
s Policy No. -.Company_ •` z 'ti r ,'b -f,ra.
q, Copyas flled with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS"COMPENSATION INSURANCE.
(This section need not be completed If the permit" Is for one hundred dollar: ($.100) valuation
or less.) - - - - - -
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any parson In any manner so as to become subject to the Workers' Compensation
Laws of California.
Date - owner
NOTICE TO APPLICANT: )f, 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 shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby 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 subject to
expiration It 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
HARD COPYI
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description 800 Afmitim to 1%bbile ame
Sq. Ft. Q No. No. Dw.
Size: Stories Units -
New ❑ Add Alter ❑ Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep: -
Plan Chk. Bal... .
Const:'
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
MOO -
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
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO.. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP.)EOUIP.
DRINKING FOUNTAIN
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
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(AUTOj(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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. FT. @ c
BATH TUB
SO. FT. r@ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 V. a
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ic
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMITTEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 6 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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.)EOUIP.
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.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINTfIALS.
,
GARDEN WALL FINAL
--