05927 (SFD)Building
Address . 78--690 Via jtjelodi t
Owner
Baareon Dev.
Mailing
Address 743 Pgret Rd., 1
City Zip Tel.
- CAt City X2234.
Contractor
same
Address
City lZip I Tel.
State Lic.
& Classif. '337077
Arch.,'Engr:;"
Designer
QUM&
.414 . �
P.O. BOX 1504 N U. �T d
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
773=9024_.. , . Legal, Description dam 11 Lot 10
Project Description Plata 2004 Parc La Omuta
City
Lic. # 3219
Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under,, provisions of Chapter 9 (commencing with Section
70Dp) of Division of th Business and Prgfessions Code, and my license is in f 711 force and
effect. a �r ,-: �' f � •.a6'>f1 1
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Busmess 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 for a permit
subjects the applicant to a civ8 penalty of not more than Ove hundred dollars (5500).
❑ 1, 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 sold within oneyear of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ 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.)
❑ 1 am exempt under Sec B. t. 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
Workers 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 (5100) valuation
or less.)
I certify that in the performance of the 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
aliforniaDateOwner '
NOTICE TO APPLICANT: n, 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.
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 Address
This is abuilding 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 i`n'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
Sq. Ft. � No. No. Dw.
Size - Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
102,026.00
PERMIT '
BY:
AMOUNT
Plan Chk. Dep.
Front Setback from Center Line
Plan Chk. Bal.
_
:W: •
Const. _
Side Setback from Property Line
W •
Mech. -/J*Uki
INSPECTOR
Electrical
' ` e113030
Date Permit
Plumbing
138.5U--
3 . QS.M.I.
S.M.I.
. Z
Grading
\\
Driveway Enc.
Infrastructure
TOTAL
REMARKS
l� ✓•°`iF�tifa"+4"F''' $,' t Ui IiX•"
2L--
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
d39
'
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADEZ
7 H PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TA
p UGH WIRING,
MOB]LEHOME SVC.
BAR SINK
POR. SO. FT. ®
I' 710 AS (ROUGH) r! iy �!
METER LOOP
GAR. Sp, FT. ®
POWER OUTLET
ROOF DRAINS
OF
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WATER HEATER
WALL Sp. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SOFT®
WATER SYSTEM
URINAL
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
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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
v
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEZ
7 H PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TA
p UGH WIRING,
DUCT WORK
ROCKSTORAGE
FOUND. REINF. 7
I' 710 AS (ROUGH) r! iy �!
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
OF
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ -Plus-X$-=$
LUMBER GR. 9 FINAL INSP.
FINAL INSP.
FRAMINGA/Aff /h Id
ROOFING o3e, a
VENTILATION
FIRE ZONE ROOFING: 7 �%
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING fpWA
MESH
INSULATIONISOUND LOW
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
ccurc nuw�
REMARKS:
SIGNATURESIINITIALS
GARDEN WALL FINAL