05930 (SFD)4
P.O. BOX 1504 N o .
Building 78-725 Via Corri &T 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
vwncm rr. �_ I
iiB.L"COR ftv.
Mailing
Address 63-713 Pin Rd.
City . Cat City I
Zip 92234 Tel. 773402$
Contractor
581
Address
Tela
05930
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description MIGIDI1 Lot 3
Project Description Flan 1804 Parc IA Our-nt:a
• State Lic.,City
& Classif.337077 Lic. # 1213. Sq. Ft. No. No. Dw.
Arch., Engr:, -
Size StoriesUnits
Designer Newt] Add ❑ Alter ❑ Repair ❑ Demolition ❑
.4.,
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 lP,rofe(g ions Code, and my license is in full force and
effect.
SIGNATUREDA. E
.;, OWNER -BUILDER DECLARATION
:-_ I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usfness and Professions Code: Any city or county which requires a
permit to construct, after. Improve, demofish, or repair any structure, prior to Its Issuance also
requires the applicant for such permit to Me 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 vi kWion of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenally of not more than rove hundred dollars (8500).
q 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, Bufsness and
Professions Code: The Contacto'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 kniprovements are not intended or offered for sale. If, however, the building
or improvement is sold withrn 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.)
❑ 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 contractor(s) Ecensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
.❑ Copy is filed with the city. 0 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 the work for which this permit is issued, I shall not
employ any person m any manner so as to become subject to the Workers' Compensation
Laws of California
Date owner Z
NOTICE TO APPLICANT !l, 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 Perri t 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. 309.7, Civil Code.)
Lenders Name
Lenders 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.
Signature of applicant Date'
Mailing Address
City, State, Zip
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
Estimated Valuation
91,604 r00
INSPECTOR
PERMIT
Datel-'16~i3 Permit
AMOUNT
Plan Chk. Dep.
Validated by:
Plan Chk. Bat.
Validation:
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
3
3535;46-
w�
REMARKS
REMARKS
x ; „x "•.'_ , .
V 'rfl;cYi/S-. �4'YA:•Y•' b• 1.0 1
i-SL."'%.iM•'�f V. Vim "V
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:
Datel-'16~i3 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE 7/ /
YARD SPKLR SYSTEM
2ND FL SQ. FT.
BONDING
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
ROCK STORAGE
DRAINAGE PIPING
CAR P. SO. FT. ®
(ROUGH)
METER LOOP
WALL SQ. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GROUT
FLOOR DRAIN
MECHANICAL FEES
SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
plus x$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V/ic
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBINd
71 UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 7/ /
oe�P
UGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TA ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. .7(lGAS
(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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 -f cQ e•
FINAL INSP.
ROOFING Z3
� �
/ R
eg
D �%
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING O�///y��/
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL