06927 (SFD)T,it!t
P.O. BOX •1504 No. 06927
Building
Address 78-560 Via Nelodia
Owner
RCCN DEVELOP NT
Mailin
Address 68-713 Perez. Road, #1
CityCathedral Cityzip 92234 1
..i-otasc
Contractor .4"4 a*.
City
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic.33%®�7 (City £23
& Classif. Lic. #
Arch., Engr.,
Designer
Address, Tel
City/ Zip (State
I
(
I
/ Lic. #
' LICENSED CONTRACTOR'S DECLARATION
I hereby affirm'that 1 am licensed under provisions of Chapter 9 (commencing with
D00) of,Division 3rof the Business and Professions Code;'and my license's in full h
ffe) /tyi.p7. " : /"Z/', , r-r1�� r , uG&' e :r e
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, Improve, demolish, or- repair any structure, prior to .its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions or 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 or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty 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 or 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 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 of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 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 ($100) valuation
or less.)
I certify that in the performance of thg 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: lt, after making this Certifrcate of Exemption you should become
subject to the Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shall 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.)
Lenders Name-
Lenders
ame
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 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 hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City,. State, Zip
JILDING: TYPE CONST. OCC: GRP.
Tract #Z1 •4. Phase iY
P. Number
gal Description MG. LA 14UINIA
oject Description
Plan Z22Z u), Lot Z
Sq. Ft. 2,42 No. No. Dw.
Size Stories Units
Newt Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation_ 2sa
PERMIT
AMOUNT
Plan Chk. Dep.
Distances:
Plan Chk. Bal.
Front Setback from Center Line
Const.
Rear Setback,from Rear Prop. Line
Mech.
6101. 00
Electrical
120.79
Plumbing
144.50
S.M.I.
7.91
Grading
Validated by:
Driveway Enc.
Infrastructure
2s523.63
r
1
TOTAL
1 . 4,11.2.93 •
REMARKS4!,6s.,^A 41
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
2ND FL SO. FT.
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
GAR. SO, FT. @
POWER OUTLET
ROOF DRAINS
GAS (ROUGH) U ` METER LOOP
DRAINAGE PIPING
CAR P. I SO. FT. ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
WALL SO. FT.
DRINKING FOUNTAIN.
FT ®
WATER HEATER SERVICE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
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
IKITCHEN 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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Yac
HOUSE SEWER
INSULATION/SOUNDS / a '
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 V
GROUND PLUMBING U=ERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANKII TOUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF
GAS (ROUGH) U ` 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.
y FINAL INSP,S
FRAMING h2h Pvl,\
FINAL INSP. —
ROOFING3 &2At) V—
^ 3 /� /� d Q
lLa4.`n- G l{ K �"
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
INSULATION/SOUNDS / a '
FINISH GRADING
FINAL INSPECTIO
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1