05252 (SFD)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 48^-103 Via i9ereasa LA QUINTA, CALIFORNIA 92253
Owner
Address 9010 Corbin AVe... Suite l
City Zip lNorthridge-9132']T7e__'
818-34'
Contractor
Address
City Zip Tel.
Pala Desert 92260 3415
State Lic. City
& Classif. 195323 Lic. #
Arch:, Engr.,
Designer
Address, 1 Tel.
No.
JILDING:-TYPE CONST. OCC: GRP.
P -Number 6t7-640--020
—5$014 Legal Description
Project Description Playa 3B. Lot 20
City I Zip I State
Lic. #
(^ti LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of:Chapter 9 (commencing, with Section
7000) of biv(�ision 3 of the Business and Professnons,Code, and my license iiss,iinnif�u'll folice,and
eifect.A r'.r,,� .r .✓`.l ��? , v A : sxs?t •S . + I� ✓ ' 7- t'
SIGNATII .+✓ ° 'M ,�' J DATE
T 1 OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reasOm (Sec. 7031.5,6usiness and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requ®es the applicant for such permit to We a signed statement that he is licensed pursuant to
Me 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
Ibr the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenalty of not more than five hundred dollars ($500)
❑ 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
bunts 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
of 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 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 or property who builds or improves thereon, and who contracts for
such prulecls with a contractor(s) ficensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
w�trereby affirm that I have a certificate of consent to self -insure, or a certificate of
pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No .Company
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the pemnit is for one hundred dollars (E100) valuation
or fess.)
certify that in the performance of thq 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
aliforniaDateOwner
NOTICE TO APPLICANT: ft, after making this Certificate of Exemption you should become
suAhoct to the Workers' Compensation provisions of the Labor Code, you must forthwith
co py with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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.)
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.
certity that 1 have read this application and state that the above information is correct.
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
05,252
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback fromnReat.P,rop.'Line
Side Street Setback from Center Line
Side Setback frorrr Prdperty Line
FINAL DATEINSPECTOR
Issued by: Date x %#}' i Permit
Validated by:
, Validation:
Sq. Ft. 1980 r
Size. r
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$102,226
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
lis` '269.83
Const.
440.50
Mech.
19 Ota
Electrical.
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
2.300.09
TOTAL
REMARKS
_-
,tt
.�. 1
0, L1..'�..01
Jik& wti':0i44",�!- -io
A.V irn.)ft
.11 flJo Bink. 4. W'v:.0%.0 .'✓
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback fromnReat.P,rop.'Line
Side Street Setback from Center Line
Side Setback frorrr Prdperty Line
FINAL DATEINSPECTOR
Issued by: Date x %#}' i Permit
Validated by:
, Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
4!�RADE'
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) O
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) le
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING .2 y
FLOOR DRAIN
MECHANICAL FEES
IF f
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
INSULATIONISOUND
SQ.FT.GAR ® 3/ic
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 PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
4!�RADE'
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) O
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) le
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
n n
FINAL INSP. f% ��!�1
111
FRAMING .2 y
FINAL INSP.
ROOFING �9
v
IF f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING %l�l(/ 3
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
k