06924 (SFD)ce., 4 4Qw
P.O. BOX 1504
Building��. fa 1��18 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
SARCOK DEVELOPMENT
Mailin
Address 58-713 Perez ltd, #1
City Cathedral Cid 1p 92234 Tel -773=9024
Contractor
Address
State Lic.337{(77 I City 1219
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City'�.,i7 (Zip (State
,• 1� Lic. #
LICENSED CONTRACTOR'S
I hereby,affirm,that I am licensed under orovisions
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bseness and Professions Code: Any city or county -which requires a
Permit to constnxY, after, improve, demorsh, or repair any structure, prior to its issuance also
requires the applicant for such permft 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 for a permit
subjects the applicant to a civ8penally 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 Contractors 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 wfthin one year of completion, the owner -builder will have the burden
Of proving that he did not bbd or krprove for the purpose of sale.)
❑ 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 of property who builds or improves thereon, and who contracts for
such projects with a comrador(s) 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 her 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 (pmpany
17 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I 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
aliforniaDateOwner
NOTICE TO APPLICANT. !f, after making this Certi irate of Exemption you should become
subject to the workers' Corrpansation provisions of the Labor Code, you must forthwith
COMPfY 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
Lenders Address
This is a"building permit when propeAy filled out, signed and validated, and is subject to.
expiration it work thereunder is suspended for 180 days.
1 cerlify that 1 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 hineby authorize representatives .of this city to enter the •above.
mentioned property for inspection purposes.
Signature of applicant— Date
Mailing Addie s
City,. state, Zip
No. 06924
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number Tract #21555-4, Phase IV
Legal Description
Project Description PARC LA QJINTA
Plan 1740 (E), Lot #24
Sq. Ft. 1'74 No. No. Dw.
Size Stories Units
NeAK Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
I
Estimated Valuation $88.574
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
494.26
Const.
tBu..ou
Mech.
66. 50
Electrical
102.60
Plumbing
120,50
S.M.I.
>..
Grading
Driveway Enc.
Infrastructure
>g�.
r
TOTAL
REMARKS n &15
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. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROCK STORAGE
FOUND. REINF.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL) g.TEMP.
POLE
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
® et—REMARKS:
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, 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.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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 �Moe aDERGROUND
C
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK( 0 r/ -
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGV/nh' 17
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) g.TEMP.
POLE
GROUT.
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING fZ ZQ EvN
FINAL INSP.
ROOFING � 2
® et—REMARKS:
to—�
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
L7CTHING36 Gj� i✓�..
MESH
INSULATIONISOUND V
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1