04102 (SFD)I
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-719 rirestone LA QUINTA, CALIFORNIA 92253
Owner
"iduclZiLy BUILDING: -TYPE CONST.
Address 75--005 Gauntry Club Drive, . „ _ A.P. Number,
City Zip . Tel. '- - " ` - '
calm Denext 92260 W 560 t'26zo
Contractor
Address
City jZip Tel.
State c. City
& Cla sl f. 288130 I L'Ic. # -328 ,
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I em 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,Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to Its issuance also
requires the applicantfor, such permit to file a signed statement that he is licensed pursuant to
the provisions 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 exemption. -Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O 1, 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 'Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that suchimprovements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
O 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 improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I 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. Company
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 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: If, alter 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
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 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Legal Description
OCC. GRP.
04 1102
Project Description Phase 1OBf Plan 300
Sq. Ft.. 2825 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation X194 A92
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
5ws.1u
Const.
670.30
Mech.
Ss. 00
Electrical
121.71
Plumbing
136.50
S.M.I.
13.62
Grading
Driveway Enc.
Infrastructure
4080.51
80.57
TOTAL
$5,933.00 It - -51-1.' nie-t
REMARKS
�4�Ara ;• rT..;�t4+fy .yii:L7Rt!1��i� �itt� yt n/, i1}
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
6/7/09
Issued by: Date Permit
Validated by:
Validation:
IWHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
L FEES NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER(AUTONDISHI
GARBAGE DISPOSAL
LAUNDRYTRAY
KITCHEN SINK
WATER CLOSET
LAVATORY
SHOWER
BATH TUB
WATER HEATER
SEWAGE DISPOSAL
HOUSE SEWER
GAS PIPING
PERMIT FEE
ELECT.FEE SMIFEE PLUMB FEE
HEATING 8 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 APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
,� ERVICE
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
FI ISH GRADING
gf�INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
PROJECT
ADDRESS
DAVE STEAVENS
Inspection Services
�,� '/YI '( /)
� 7
-.•LnG.+t� I I�tr?.J �
BLDG. PERMIT #
ENGINEER , �,.]/:J
INSPECTION TYPE
PROJECT #
Page of
CLIENT
DATE 'u L 4
ARCHITECT
CONTRACTOR
INSPECTION REPORT
r f;
7 5 i I*1 A 7 i t [ a
r -7/S 7 r_cI
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
the locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. S J `' S y INSPECTOR NAME f� -V
(Print Clearly)
DATE 0 Z' INSPECTOR SIGNATURE
_.� AVE STEAVENS;
Inspection Ser Ides
w
K`t
PROJECT 6A WrE ST' At"filba PROJECT. # v0 -'AJ -2 09
A?DRESS-$V- 8: 74 3, t' CLIENT 6J -A unsr Sr H o N
,,��' 1 P O J a DATE t..`# 2
t.
BLDG. PERMIT # ARCHITECT iR A ec sq
t
ENGINEER Ui•}J� . A�iq/ �iJC , t CONTRACTOR, W AA Ay 0,
INSPECTION TYPE
INSPECTION REPORT
Page # of
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CERTIFICATION OFWMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially complies:with approved plans, specffications:and applicable sections of the building codes. This report covers
wns of the work inspected only and does not -constitute engineering opinion or project control.
CERT NO. 0� �r 0 '"f' ' f. INSPECTOR NAME v l A t.� .5 A J
DATE «amu tV- INSPECTOR SIGNATURE?_ •