07259 (SFD)T At!t 4
P.O. BOX 1504 No. 07259
Building 78-105 CALLE ESTADO
Address 78-230 Via Sevilla LA QUINTA, CALIFORNIA 92253
Deane efts
Mailing'
Address 15 Agusta Drive
City Zip Tel.
Rancho 14ir ge .92270 321-8004
Contractor
Same
Address .
State Lic. City
& Classif. 5092M I Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I her taffirm that I am licensednd
uer provisions of Chapter 9 (commencing with Section
7000) of Diiv,ision�g3 a�of the Business aped P,ro,.fespAsions Code, and my license is in dun force and
effect.1.I✓�J a��fa- �G
_SIGNATURE • T DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I 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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such peril to Me 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,'r Any violation of Sermon 7031.5 by •any applicant for a permit
subjects the applicant to a civil penally of not more than five hundred dollars (5500).
❑ 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 improvements are not intended or offered for sale. fl, however, the building
or improvement is sold within one year of completion, the owner -budder wig 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 buuMs 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. R, g, P.C. for this reason
Date Owner
+ A W qT
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, 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: ff, after making Oris 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 shag 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 a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days -
1 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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 613-402.004, 009* 010
Legal Description lent. %r. Ito. 23932
Project Description Phase I — A
Lot 11
Sq. Ft. 27€ 0 No. I � Wit No. Dw.
Size . . Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $134,038
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal..rwiiS
Const.
Mech.
Electrical
Plumbing
I. -Is. 5u
S.M.I.
9.
Grading
Driveway Enc.
Infrastructure
•�,a. $+.moi
TOTAL
$4,1W. i' 's C)b r
REMARKS
#lib$"4?..ffs :3_i nr(.,t�:r.r -y17t
ZONE: I 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
IST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WIRING
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
GAS (ROUGH) 94he
METER LOOP
DRAINAGE PIPING
CAR P. SO. FT. ®
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN.
WALL SD. FT.
GROUT
WATER HEATER
SERVICE
URINAL
SQ. FT.
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
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
ROOFING �/�
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,TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ®c I
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® Vic
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE __J___MECH.FEE
PL.CK.FEE
TNST. FEE ELECT. FEE
$MI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMB 6
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REI
GAS (ROUGH) 94he
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. !d L
v
FRAMING O
FINAL INSP.
ROOFING �/�
` / r l� (� �� / Cj4
✓� I` 06T f/
1° P
/
n Z ,/
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
TU G 2Z ,a
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL