07258P.O. BOX 1504 No. 07,258
Building a 7&105 CALLE ESTADO
Address X555 Via Del Monte LA QUINTA, CALIFORNIA 92253
Deane Himms
Mailing
Address 155 Agusta 'Dui Yd
City Zip Tel.
oho iii r Qe .92270 1 3218004
Address.
Tel.:
State Lic. City
& Classif. 50208 Lic. #
Arch., Engr.,
Designer
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 Dmsion 3 of. Me Business Protpssions Cade, and my lithos ill in full.for�e and
effect , p z `e. 9. `• r
SIGNAIURE Y '"_l `^1 �wr DATE
OWNEWBUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.E and Pmtessions Code: Any city or. county which requires a
Permit to construct. alter. improve, derno", or repair any structure, Prior to its issuance also
requires Me applicant for such permit to file a signed statementthat he is licensed pursuant to
the provisioins of Me Contractors 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 exenw0m. Any vioWion of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a ciW penalty of not more than five hundred dollars (S500).
❑ 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
Processions Code: The Contractors License Law does not apply to an owner of property who
builds or improves thereon and who roes such work himself or through his own employees,
Provided that such improvements are not intended or offered for sale. If, however, the bufiding
' or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build orrrprove for the purpose of safe.)
❑ 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 appy to an owner of property who builds or improves thereon, and who contracts for
such projects with a arrtractofs) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B: & P.C. for this reason
Date Owner
WORKERS' COMPENSATION. DECLARATION
1 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
❑ Copy is filed with the city. ❑ Certified copy is hereby. fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed O the Permit is for one hundred dollars ($100) valuation
or less.)
1 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,
aliforniaDate Owner
N077CE 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 Orfs perrid shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that thre eis a construction lending agency for the performance of .the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's 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 100 days.
I certity 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
BUILDING: TYPE CONST.' OCC: GRP.
A.P. Number 513-402404, 009., 010
Legal Description
/Tent. Tr. No. 23371
Phase 1 q
Project Description.
Lot 79
REMARKS A.% -an A :A,4 ,. 4t'A. Jln , rc
it,
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: Date Permit
Validated by:
Validation:
Sq. Ft.rg1Qo ;
Size
No.
Stories %
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition 01
Estimated Valuation
$1111927
PERMIT
AMOUNT e
Plan Chk. Dep.
_
Plan Chk. Bal.
Const.
R • �_
Mech.
~
Electrical
+�
Plumbing
•
S.M.I.
Grading
Driveway Enc.
Infrastructure
& U Ia.? 4V
TOTAL
i1"!~a.w u•�a
:�_ `1 ✓:
REMARKS A.% -an A :A,4 ,. 4t'A. Jln , rc
it,
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: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH) C1D
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
q /
FINAL INSP. [ /�i�� q0 ��
111
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3dc
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE TLLIMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. 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./ L
GAS (ROUGH) C1D
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.
q /
FINAL INSP. [ /�i�� q0 ��
111
FRAMING 9/7/yo z7
FINAL INSP. ql C9
Alkl /
fo-
�l v
REMARKS:ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
NUQI c✓ f (C3 '9e
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTIO a'�Qt
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL