06914 (SFD)4
P.O. BOX 1504 No.
Building 78-105 CALLE ESTADO
Address 78-560 Via Sonata LA QUINTA, CALIFORNIA 92253
Owner
Mailin
Address. 68-713 Perez Road, #1
City cathedral Cf$. 'p 92234 Tel -773-9024
Contractor
State Lic.-�City
& Classif. 34-1077 Lic. # 1219
Arch:, Engr.,
Designer
Address* Tel.
City IZip I State
157 Lic. #
,,r'`LNCENSED CONTRACTOWS DECLARATION
I hereby`affirm tha41 am licensed under Provisions of Chapter 9 (co
7000) of Division9 of the Biusiriess and Professions Code, and my lic
effect. ;;�'" �` N',r'j .Ir /'..,.+' �-�,"..°.'s"..'t.^!i' ..✓ `t./
OWNER41UILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13s ness and Phdiassiam Code: Any city or county which requires a
Permit to construct, alter, improve, demolish. or repair any structure, prior to its issuance also
requires the applicant for such permit to tie 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 viota<iorh of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penally of rat moreflan 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, Suisness and
Professions Code: The Contractor's License Law does not appy 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 safe. If, however, the building
or improvement is sok/ within one year of completion, the owner -budder will have the burden
of proving that he did not build or irprove for the purpose of safe.)
❑ 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 appy to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) icersed pursues t to the Contractor's License Law.)
❑ 1 am exempt under Sec_ R_ & 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 Comparry
❑ 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 ($100) valuation
or less.)
I certify that in the performance of thg 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- 9, after makiM tins Certificate of Exemptfon you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shaftbe 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.) _
Lender's Name
Lender's Address
' permit This is a building peit when property filled out, signed and validated, and is subject to
expiration if 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
11LDING: TYPE CONST. A r a OCC: GRP.
P. Number Tract #21555-4>,
fl69s4
Phase IV
,Legal Description C LA n
Project Description
Plan
Plan 2222 (0).. Lot #14
Sq. Ft. 2x222 No. No. Dw.
Size Stories Units
NewYO Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation �l12�161
PERMIT
AMOUNT
Plan Chk. Dep:
Plan Chk. Bal.
57
Const.
6€5.,00
Mech.
60.00
Electrical
120.79
Plumbing
144.50
S.M.I.
7.91
Grading
Driveway Enc.
Infrastructure
�fa523.6 '
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
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. SD. FT. ®
WALL SO. FT. 0
DRINKING FOUNTAIN.
SERVICE
FINAL INSP.
URINAL
SO. FT.
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
yd.
$ -Plus-x$-=$
WATER PIPING
NOTE: Not to be used as property tax valuation
�y 9
FINAL INSP. ��L
FLOOR DRAIN
MECHANICAL FEES
ROOFING 3
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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 I
IBATH TUB
LATHING
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
GROUND PLUMBINGUNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
OUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) / D
/
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd.
$ -Plus-x$-=$
LUMBER GR.
�y 9
FINAL INSP. ��L
FRAMING 3 / O "
FINAL INSP.
ROOFING 3
(vy�
n� /_ �J/
/�j �f`fT�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND /vclo
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL:d
I