04661 (MFD5)-------__ ---__..— - ---_
w
44661
• - - P.O. BOX 1504
Building "�
Address 32 F x"0atOrle LA.QUINTA, CALIFORNIA 92253
Owner
'Mailing' ,
Address
75 Coantry Club
'City Zip Tel.
zte�ar 9xA 568;7288
Contractor
Addresse , ;
. d _
City,
Zip
Tel.
Plan Chk. Bal.
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State Lic. a
i£ Classif.' � 282 1.30 ,•
City
Lic. # .398.._ ,
Arch., Engr h. ,
Designer ,
Address -
Tel.
,• r
City=
Zip
State
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S. M.I.
Lic. #
LICENSED CONTRACTOR'S DECLARATION f
I hereby rm affithat 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,a,_ 1
SIGNATURE DATE
's✓ OWNER -BUILDER DECLARATION
- I hereby affirm that I am exempt from the Contractor's License Law for the following
reason:'(Sec. 7031.5,Suslness and Professions Code: Any city or county which requires a
permlt;to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for 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 bask
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 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 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,
sale. If.
orovided that imp oveme'ntu's snddwithin one, yearts are of intended or
offered owner -builder however,
have thebuilding
bburdlen
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 con
atruct,the. project. (Sec.,t7044, 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. 8 P.C. for this reason
Date •' Owner
t
z 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
q: ❑ Copy is filed 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 dollars ($100) valuation
or less.) . '
I certify that in the performance of thg 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 Call ornia.
Date Owner
NOTICE To APPLICANT., If, 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.
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number PGA Wast TheN m>~aAna
,Legal Description
Project Description Phase ElArs Plan 8
Sq. Ft. 1536 No. . - No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $1081516
PERMIT AMOUNT
Plan Chk. Dep.
Side Street Setback from Center Line
Plan Chk. Bal.
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Const.
yy • t)V
Mech.
FINAL DATE
-y .00
Electrical
09 + edz
Plumbing
Issued by:
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S. M.I.
y . o v
Grading
Driveway Enc.
Validated by:
Infrastructure
41;Z s,tA4
is �
iU LX(3tAA,C
3r ZZU•UI
City, 'State, ZIP
.
r WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
1 ,
TOTAL
*A /.55
REMARKS
1. 1.4 4ty l... vt..l .? 7 . t:1,a s :�
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
h `�• CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby 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
Lender's' Name
Lender's:. Address
This Is a -building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
SP CTOR
� 37
expiration If work thereunder is suspended for 180 days.
tt
I certify thatA 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
.
r WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
1 ,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
tST FL SO FT rp $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
SPKLR SYSTEM
2ND FL SO FT. aYARD
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. Cr
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. fpr
TEMP. POLE
' GROUT
a
DRAINAGE PIPING
CAR P. I SO FT. a
FINAL INSP.
WALL SO. FT. Q
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
CU. yd.
$ plus x$
_$
URINAL
SO. FT. 0
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION S
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(AUTOYDISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRYTRAY
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
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 1Y. c
SEWAGE DISPOSAL
SO.FT.GAR fs 3Ac
HOUSE SEWER
�fINAL INSPECTION�_f�
[[
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE I L.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE 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 APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
' GROUT
a
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
FI SH GRADING
�fINAL INSPECTION�_f�
[[
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL