05247 (SFD)Tjhf 4 4 a"
Building
Address 48-123 Via "Hermosa
Address n 9 n r.n
rh
City Zip
P.O. BOX 1504
783105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address
_72-200 Al uneSota
7in IT.1 '
State Lic. City
& Classif. g dr, 21212 Lic- #
Designer
Address Tel.
City(Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that I am licensed under provisions of Chapter 9 (commencing withSection7000) of Division 3 of the Business and Professions Code, and my license is in full force ancLn
effect_
SIGNATURE.•+'r' "" tri. r ar F• + +.+/ / PATE
OWNER -BUILDER DECLARATION r f
�1_ I hereby affirm that I am exempt from the Contractor's License Law for the following
reason:• -(sec- 7031.5,Bhsihess and Professions Code: Any city or county which regimes a
permit to construct, after, Improve, demolish, or repair any structure, prior to Its issrmreee aso
requires the applicant for such pemvt to file a signed statement'that he is licensed pursuard to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
alvision 3 of the Business and Professions Code, or that. he is exempt therefrom, and the bass
for the alleged "exemption. Any violation of Section 7031.5 by 'any applicant for a pemtit
sutgects the appficarht to a avd penalty of not more than rive hundred dollars (S500).
❑ 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,-&dsress 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 though his own employees,
provided that' sari improvements are not intended or offered for sale. It, however, the bur7ding
or improvement is sold within one year of completion, the owner -builder wiig 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
strucl the project. (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or Improves thereon, and who contrads for
such projects with a contractor(s) licensed pursuant to the Contractors License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION -
I hereby affirm that I 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. ❑ 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) vakation
or less.) .
I certify that in the performance of thg work for which this permit is issued, I stall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: 11 after making this Certificate of Exemption you should became
subject to the Workers' Compensation provisions of the Labor Code, you mus huthwith
comply with such provisions or this permit shall be deemed revaked.
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.)
Lenders Name-
Lenders
ame
Lenders Address
This is abuilding 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 laves 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
No. 0524?
LDING: TYPE -CONST. ..00C: GRP.-
. Number
RP..Number A17-_AAh.4.,a1A
Legal Description
Project Description' 'Alts Q_nt In
Sq- Ft- No. No. Dw.
Size, i��v� Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
S 16 A RI ,
Const.
440.50
Mech.
39-(101
Electrical
. A G
Plumbing
00 .
S.M.I.
Grading
Driveway Enc.
Infrastructure
2.300.09
Ering—T-ned Lizard
W
1,.
TOTAL
9�. 68. 10
1
REMARKS
ZONE BY:
Minimum Setback Distances:
Front Setback from Center: Line
Rear Setback f from Rea Prop. Line t
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: ' Date 1 a d Permit
Validated by:
Validation: -
1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
B GRADE ��
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. I SQ. FT. ®
WALL SQ. FT. ®
DRINKING FOUNTAIN
SERVICE
FINAL INSP.
URINAL
SQ FT ®
WATER SYSTEM
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
GRADING
yd.
plus x$
WATER PIPING
NOTE: Not to be used as property tax valuation
/yFINAL
FRAMING x q O�00,
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L 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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
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 R AIR COND. SOLAR
SETBACK
NO PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE ��
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
(FINAL
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
INSP. 1' 116—cu.
GRADING
yd.
plus x$
-$
LUMBER GR.
•L
/yFINAL
FRAMING x q O�00,
ROOFING
//0 0
!/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND 6
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL