002696 (3&4)P.O. BOX 1504 No. 002696
Building 78-105 CALLE ESTADO
AddressLA QUINTA, CALIFORNIA 92253
&=
Mailing
Address 75.805 Om=tW Club Wve
City Zip Tel.
Palm Det 92260 568-2828
Contractor
ress
State Lic.
& Classif.283130 .
Arch.,'Engr., - -
Designer
Address
IZip I Tel.'
City .
Lic. # 328
Tel.
UILDING: TYPE CONST. . OCC. GRP.
.P. Number
egal,Description
roject Description PIZ MM Na 13 B
Plan 10 OR
Sq. Ft. I= 2272 No.
Size-� Stories.
New U9 Add ❑ Alter ❑. : Repair ❑
No. Dw.
Units
CityZip
4 BY:
State
Lic: #
Front Setback.from Center Line
LICENSED CONTRACTOR'S DECLARATION
I hereby affirmdhat 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 amendcl-
,/
Rear Setback from Rear Prop. Line
SIGNATURE—f' Z `DATE
' /bWNER•BUILDER DECLARATION /r
I hereby affirm that Ilam exempt from the Contractor's License Law for the following.
reason: (Sec. 703.1. 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'penafty 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' 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.) ,
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
slruct 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 projectswitha contractor(s) licensed pursuant to the Contractor's License Law.) -
❑ I am exempt under Sec. B. ti P.C. for this reason
Estimated Valuation
PERMIT
. plan Chk. De
p
Plan Chk. Bal. .
Const.
Mech.
'
Electrical
Plumbing
S. M. 1. -
Grading
Driveway Enc.
Date owner
Infrastructure
11 14 33,,,S b 41 5
WORKERS' COMPENSATION DECLARATION
"I hereby affirm that 1, 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
❑ Copy is filed, with the city. . ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed tithe 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 California.
Date Owner
NOTICE TO APPLICANT: It, 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.'
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.)
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' of this city to enter the above->'
mentioned property for inspection purposes.
Signature of applicant r = i- Date /►
Mailing Address
City, State, Zip
HARD COPY
Demolition ❑
AMOUNT
r sn. �rw
.Y'lC.Y • 'Iy
ele rr.rry
REMARKS
ZONE:
4 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:
A6731
11 14 33,,,S b 41 5
I1ST FL. SO. FT. ® UNITS
en r IYARD �—SPKLRSYSTEM I
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT. ®
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION Is
MOBILEHOME SVC.
POWER OUTLET
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SAS (ROUGH) G \
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APP./EQUIP.
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
GRADING
CU. yd.
$ plus x$
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 111/4 c
SEWAGE DISPOSAL
INSP. 5 ��,
J
SQ.FT.GAR ® 3/ac
HOUSE SEWER
IELECT.FEE
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
2Zj6ETBACK /,� -a - �-G
UdROUND PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
't6CSLAB GRADE ! -� -�
OUGH PLUM 1
BONDING
HEATING (ROUGH)
STORAGE TANK
)�(fFORMS ,-
EWER OR S 2C
UGH WIRING C
/
DUCT WORK
ROCK STORAGE
&J,�fFOUND. REINF. /2
SAS (ROUGH) G \
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
7 L/LREINF. STEEL 12 3
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
aeNAL INSP _a
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
_$
LUMBER GR.
/2G�tNAL INSP.
lJFRAMING 3NAL
INSP. 5 ��,
J
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
0,6LATHING L .- IF -Y?
MESH
NSULATION/SOUND
FINISH GRADING
?LeFINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL