05923 (SFD)f 0, . T4t!t 4 4 Q"
Building 78--675 Via Helodia
Address
Mailing
Address 5$-713 Perez Rd.
City Zip
cng city 92234
Contractor
38II�
Address
Zip
State Lic.
&CIassif1'..M7077
' ,.4a.Arch., Engr.,
Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA,>QALIFORNIA 92253
Tel.
'773-30'24
Tela
City
Lic. # 1219
Tel.
City Zip State
Lic. #
' LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3/ of the Business.��♦f1d Pr/,' fessions Code, and my license is in jfull force and
I. g /'7 t mit fi5q
SIGNATURE '• "' DATE
OWNER -BUILDER DECLARATION
I hereby affimt that I am exempt from the Contractor's License Law for the following
Mason: (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 tlie`appliicant for such permit to ne 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 cid penafly 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 sokd within one year of completion, the owner -builder will have the burden
.of proving that he did not build or inprove for the purpose of sale.)
O 1, as owner of the property, am exclusively contracting with licensed contractors to corn
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 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 Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(Thls section need not be completed if the permit Js for one hundred dollars IS 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
NOTICE TO APPLICANT: g, after making this Certificate of Exemption 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.
CONSTRUCTIONLENDING 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
No. 05923
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description Phase YT Lot 14
Project Description Plan 2222 -Pare La Ouinta
Sq. Ft. 2227. No. No. DIN.
Size Stories Units
New m Add ❑ Alter ❑ Repair ❑ 'Demolition.❑
Estimated Valuation 1-12' 161.00
PERMIT 'k -%A AMOUNT
Plan Chk:kDep.
Plan Chk. Bal. • t
Const. 663.00
Mech. +W
Electrical 12U. 19
Plumbing 144.JU
S.M.I.
Grading
Driveway Enc.
Infrastructure 2523.63
' a
r
TOTAL
REMARKS Ssht:; tt«€r14.^k3iyt Ott, a t'o 7{ E7t «t n� i A
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
� r
FINAL DATE
INSPECTOR
6-169
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF. 7A
"J
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. I SQ. FT. ®
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
WALL SQ. FT.
LUMBER GR.
DRINKING FOUNTAIN.
FRAMING %O /
I
FINAL INSP.
URINAL
SQ FT ®
REMARKS:
ESTIMATED CONSTRUCTION VALUATION $
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
SPARK ARRESTOR
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAR. FIREWALL
LAUNDRY TRAY
AIR HANDLING UNIT CFM
LATHING 4LbW N //0
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
INSPECTOR'S SIGNATURESIINITIALS
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 PLUMBIN�' ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
GROUND PLUMBING 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. 7A
"J
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.
INAL INSP
FRAMING %O /
I
FINAL INSP.
ROOFING � (?/
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 4LbW N //0
MESH
INSULATIONISOUND S
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL