04812 (MFD5)i
04812
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 55-378 Firestone LA QUINTA, CALIFORNIA 92253
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BUILDING: TYPE CONST.
A.P *Number -
Legal Description
Project Description
... _ .. .
OCC. GRP.
Pigh West — Tho Greens........
ph' 8so 8BG .• Ply �A'
Mailing
Address' -ra�i ' azn r�� C�Ib '"
City
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ipTel.Pa
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,���-429 +
Contractor
National Mortgage
Address ,
,zri,111'!� _
City
Zip
Tel.
a•
State Lic. .288130
& Classif.
City 328 -
Lic. # -
1313
Sq. Ft.
No. No. Dw.
Size
. Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 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..- `�C •' �+Cf . + _ -n /" /.Z 111. 1 Jam .
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, 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 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 (E500).
❑ 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 such improvements 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
$95,217
PERMIT
AMOUNT
Plan
plan Chk. De
Plan Chk. Bal.
�' A
Const.
b
, Mech.
uI
• U0
Electrical
C /C
15 4 f'y 4
Plumbing
lei 0 Ute
S.M.I.
LL��
• V.7
Grading
Driveway Enc.
Date Owner
Infrastructure
�C
�J o 142 • 3.rc�
I ®7 1 •:til
fin cr—Ts x
A # U7 I .
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
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
VZ r 3U +3j(-,)�i .''°Z/
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 ppeon in any manner so as to become subject to the Workers' Compensation
Laws of Cal ifornirsa. a
REMARKS
qct y ♦y�r rq� O
I 51 FVA 1 V ' tV Ml � -11 { - r)38 a 34 IV
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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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.)
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE
'
INSFECTfJ.R
// $
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.
1 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.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
GOLDENROD - ASSESSORS OFFICE, HARD COPY - FILE
City, State, Zip
r WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING,
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.. ._ .... ... -.Wim _, c ..
a. a...,.. .hl... .. .moi., .... - "_ .. _
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
SMI FEE PLUMB FEE
1 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
SAS (FINAL) 2
TEMP. POLE
GROUT
WATER HEATER lig
ICEi
57
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. y0.
$ plus xS
=3
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
INAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL 7d