12836 (AR)s P.O. BOX 1504
Building 47410 Via Koran 78-105 CALLE ESTADO
Address , LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address SaMd.,'
City Zip rel-..340-3,221.La 0 -din , CA ' 92253
Conractor - . -
s atns�es: Construction ,
Address
354. E. Desert F-aIIs Drive --
City lZip Tel.:
Palm Desert.. JM 92260 3
State Lic. a City
& Classif. ,'��13536: Lic, #
Arch., Engr.,
Designer
Address '` 1. Tel.
,_3522.
257-9
City Zip State
Lic. #
. a
ICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I a�i licensed under provisjlns of Chapter 9 (commencing with Section
Jr]y1000) of Division 3 f the Business`and Prpfe ions Code, and my license is in full force and -
.ffect. - - .f - i. r .. Al / 2'!l 6.. _
No. 32836 '
BUILDING: TYPE CONST: OCC. GRP. -
A. P.
RP.A.P. Number _
t.
Legal Description -•
Project Description • , Addition t
Sq. Ft.
Size
New
335
..Stories
Add ❑ Alter ❑
No. Dw.
Units
Repair ❑
OWNER•BUILDERDECLARATION
I hereby affirm that I'am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business 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
requires the applicant for such permit to file 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 violation of Section 7031.5 by 'any applicant fora permit
subjects the applicant to a civil penalty of not more than rive hundred dollars.(S500).
p 1, as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation. l` 'A 26,130.40"
_a ! `
-- AMOUNT r ti
PERMIT ! -•• - '
' '� '�` �, •'1
Plan Chk.'Dep. ,.•
Plan Chk. Bal. -1-72.
'Const. `, °' v ' 26,5* 00'.
-
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
Mech. t. 21.00
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
Electrical - �?(� ,,'73
or improvement is sold within one year of completion, the owner -builder will have the burden
or proving that he did not build or improve for the purpose of sale.)
Plumbing t .33 v 00
'
❑ I, 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
S.M.I..- - 2.61 f.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec..B. & P.C. for this reason
Grading
Driveway Enc:` I
Dateowner
Infrastructure ' <`
WORKERS' COMPENSATION DECLARATION
I 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.)
•`r" y .
- • • '
Policy No. Company
&C py is filed with the city: ❑ Certified copy'is hereby furnished.
v }
4' t `
TOTAL ':,. 520.5 `
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for r one hundred dollars ($100) valuation
or less.) ' -
1 certify that in the performance of the 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
NOTICE TO APPLICANT: If, after makingthis Certificate of Exemption
p you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
x "
ZONE: • BY: 'a _ �- ' a
Minimum Setback Distances: - . • ' c, ,� �- y - ';;,�
Front Setback from Center_ Line
Rear Setback from Rear Prop. Line `¢
CONSTRUCTION LENDING AGENCY
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_.)• _- .•
Side Street Setback from Center Line
•'-
Side Setback}from Property Line
Lender's Name
t.
DATE - INSPE' OR -
"'•rI
•Issued by: •Date� Permit
r
Vdlldated by: b, I V A" 'R O
- Lender's Address
';This is a buildingFINAL
permit when properly filled out, signed and -validated, and is subject to expiration it work thereunder is suspended for 180 days.
certify that I have read this application and stale that the above information is correct.,
I agree to comply with all city and county ordinances and state laws relating to building r-
construction, and hereby authorize representatives of this city to enter the -above-./�•
mentioned property for inspection purposes.
Signature of applicant Date
t'Fw
AN
Mailing Address
Validation: r. Q ; �"�� r
f
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
2ND FL. ! SQ. FT.
FORMS
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
OTHER APPJEQUIP.
DRAINAGE PIPING
WALL SQ. FT. p
TEMP. POLE
DRINKING FOUNTAIN.
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
-
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
REMARKS:
LAUNDRY TRAY
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 ® 11/4 c
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® 3/ac
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 & AIR COND. SOLAR
SETBACK
GROUND PLUMBING 3-
p 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.
GAS (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.!p 1!�
!
FRAMING -3_®2
FINAL INSP./,A
7
ROOFING /i/
Lo
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
c
LATHING
MESH
INSULATION/SOUN D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL