05924 (SFD)Building
Address 7&-735 Via
Owner
N Sal ecM DOV.
Adliress
P.O. BOX 1504
,., 78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
68-713 Perez Ed. #1 X _
Cityip Tel.
Z
Cat City 92234 773--9Q4 . .
Contractor
Sama
Address
Zip I Tel.:
State Lic. - City
& Classif' 337.0 7 Lic. # I
Arch., Engr.,
'i` 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
t 7000) of Division .of thet 3usirness d Professions Code, and my license is;in;full foo�rce and
effect. ,' __ i i?�:
SIGNATURE "' - •'DTE
E•.' "�'
'OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usiness and Professions Code: Any city or county which requires a
Permit to—St"W!,,alter, 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) or
1 Division 3 of the Business' and Prolessbons 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 c"penally 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 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 erprovarants are not intended or offered for sale. If, however, the building
or improvement 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
.tiy does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) frcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Ii 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.) '
Polici No Company
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be competed if the permit is for one hundred dollars ($100) vatuation
or less.)
1 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., If, 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
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
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 1110 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
t
No. 05924
BUILDING: TYPE CONST. OCC: GRP. -
A. R
RP.A.P. Number.
Legal. Description Phase IT Lot 20
Project Description Plan 2222 -Pare La QuInta
Sq. Ft. 2222 No. No. Dw.
Size • • Stories -Units
New I Add ❑ Alter ❑ Repair ❑- Demolition ❑
stimated Valuation
BY:
PERMIT;
AMOUNT
Plan ChkSDep. `
Plan Chk. Bal.
$7I.
Const.
C► �•�
Mech.
•
Electrical
L4U. I
Plumbing
A •`
S.M.I.
1.9t
Grading
Validation:
Driveway Enc.
Infrastructure
s•
e'
' TOTAL
0
REMARKS .
r./,-V.A,r`, Li�TOTAL-
Vy....
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:
DatePermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE F z
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM ,
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING.
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR, gQ, FT, ®
METER LOOP
HEATING (FINAL)
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
TEMP. POLE
DRAINAGE PIPING
CARP. SQ. FT. @
WATER HEATER
SERVICE
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 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 ELECTRICAL HEATING & AIR COND. SOLAR
' a�f a rags
SETBACK
GROUND PLUMBING
0 00 UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE F z
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. ff
GAS (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.
FINAL INSP. / �,�
FRAMING t®
FINAL INSP.
ROOFING
I�
AW
`
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
9
LATHING f //'� ,7/O
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
,