05238 (SFD)Building
Address 0-119 Via
Address
City
Contractor
Address
77.r260 Rl in es*ta
4
f�Gl�Gv
P.O. BOX 1504 N o .
78-105 CALLE ESTADO
gra LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE,CONST: OCC: GRP.
A.P. Number 617-640-422
Legal Description
Project Description Fkan 2-R, Tat 12
A .Co
�N
City Zip TeL
1 ar 924+<+:3 +S—
State Lic. City `
& Classif. 1 195333 Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
700 of. Division 3 of the Business and Professions Code; `and my license is in full forceandy,.�
A-1-
effect ; r
....-ei.. yr,+�.I:rs" ..-.� �.i .Ir' .+o�,r!3..•-.'.h•r,,.i ��,...p ,> �` •'7 -yr
SIGNATURE' a --""Z- L. --. e3.. -y-. .w✓•, �•F' s' �' ...�'!" DATE-
OWNER-BUILDER
ATFOWNER•BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Pfatessicns Code: Any city or county which requires a
Permit to construct, after, improve, demolsh. or repair any structure, prior to its issuance also
requires the applicant for such permit to fie a signed statement that he is licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Bustness 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 crud penalty of not more than rive 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
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 or completion, the owner -builder will have. the burden
Of proving that he did not build or inprove for the purpose of sale.)
❑ I, as owner of the property, am exclusiliety 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, 1 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: h after maAvng this Certificate or Exemption you should become
subject to the Workers' Corrnpensation provisions or the Labor Code, you must forthwith
Comply with such provisions or this Permit shaft be deemed revoked.
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.).
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 Date
Mailing Address
City, State, Zip
0-5238
Sq. Ft. 2950 No. No. Dw.
Size -Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
ZONE:
IBY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from P•rop�rty Line
FINAL DATE
INSPECTOR
Estimated Valuation
$100,928,
Issued by:
PERMIT
Validated by:
AMOUNT
Plan Chk. Dep.
Validation:
I
;
Plan Chk. Bal.
363.86
Const.
435.80
Mech.
36.00
Electrical
79.86
Plumbing
94 .,00
S.M.I.
7.04
Grading
Driveway Enc.
Infrastructure
2,270.88
Fria-ne—Toed
Lizard.
131.06
TOTAL
1$3,418.20
REMARKS
L t
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X4 Z.3i.9iq it
itifJ`lL. .5 e+r.Lre, J
ZONE:
IBY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from P•rop�rty Line
FINAL DATE
INSPECTOR
Issued by:
at Permit
Validated by:
\
Validation:
I
;
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SQ. FT. ® $
UNITS
RADE Z�
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) lolilzmv
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
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
FLOOR DRAIN
MECHANICAL FEES
t�
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/e c
SEWAGE DISPOSAL
INSULATION/SOUND
SO.FT.GAR ® 3/ec
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 A PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
RADE Z�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) lolilzmv
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING ,
cu. yd.
$ plus x$
_$
LUMBER GR.
CO FINAL INSP./j, l•_
FRAMING
FINAL INSP.
ROOFING
t�
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING /
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
t
GARDEN WALL FINAL
I