05921 (SFD)P.O. BOX 1504 No. 05921
Building 78-105 CALLE ESTADO
Address 8-X700 Via Meladia LA QUINTA, CALIFORNIA 92253
Owner
11arcon g,ev.
Mailing BUILDING:. TYPE CONST. OCC: GRP.'
Address 68-713 Ferez..rd. 01 A.P. Number
City Zip Tel.
Cal; 92235 773--9�?24 Legal Description PMSe I7 Lot 9
Contractor lam .Za22 Pare Le Quin' to
Project Description
Sam
Address
City izip I Tel::
State Lic. I City
& Classif. 337077 Lic. # 1219
Arch., Engr.,
Designer,;
Address' Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70pD) of Division13,of th4 Busin o and'Professions Code, and my license is�n full force Aandt
effect e i ir_Ij ✓lY,;� r < iii}
SIGNATURE DATE
OWNEWBUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usAress and Professions Code: Any city or county which requires a
pemrft. to construct, after, improve. demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Ale a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
11&Won 3 or the Bus -guess 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 civilpenalty of not more than Ove hundred dollars ($500).
O 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 Arprovements are not intended or offered for sale. If, however, the building
orbrprovement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve 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 contractor(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 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
O 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 (8100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, 1 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: ft, ager 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. �.
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.)
Lendefs Name
Lenders Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. ,
1 certity that Ihave 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
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft. 223
Size
No. No. Dw.
Stories Units
New+O Add ❑
Alter ❑ Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
6— 6— 9
Issued by:
Date Permit
Estimated Valuation
112,161.00
PERMIT
AMOUNT
Plan Chk. Dep.`
Plan Chk. Bal.
L
Const.: '• `US•
DO
Mech.
I t)V # V
Electrical
120. 7
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
523.is
TOTAL
REMARKS
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
6— 6— 9
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB. BONDING
--ROUGH
2ND FL. SQ. FT.
STORAGE TANK
YARD SPKLR SYSTEM
SEWER OR SEPTIC TA 7' WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
AS (ROUGH) `��r� METER LOOP
HEATING (FINAL)
GAR. SQ. FT. ®
I 1POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
CAR P. I SQ. FT. ®
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
SQ FT ®
LUMBER GR. FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
kw
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
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.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 i ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING o, UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 711 r
ROUGH PLUMB. BONDING
--ROUGH
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TA 7' WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. %/j C/�
AS (ROUGH) `��r� METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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.
FRAMING FINAL INSP.
ROOFING
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND Q
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
CCAIf^C CI AIAI
kw
REMARKS:
SIGNATURESIINITIALS
GARDEN WALL FINAL