05773 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 78-725 v META DRIV'. LA QUINTA, CALIFORNIA 92253
- TPJAD PACMC• DESS DHVR 004, MT „
Mailing
Address 74-923 IELT' 0130
. • • . , .,
City Zip Te .
P� DESS ;2260 0 9174
Contractoh= PAaFZC EUMMS COV. .
Address.
SAM
City lZip Tela ,
State Lic. I City
& Classif. 505699 Lic. # 1383
Arch., Engr., -
Designer
Address Tel.
City
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licersed.under provisions of Chapter 9 (commencing with Section
7000) of Division,3 of.the Busires_ s and Professions Code, and my license is in full force and
effect. y + t e
� SHINATLRE $ ° ° 'DATE
dwNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sac. 7031.5,Busuness and Professions Code: Any city or county which requires a
permit to construct, alter, anprove, 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 Prolessions 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 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 s 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 smproves thereon and who does such work himself or through his own employees,
provided that such irniarovements are not intended or offered for sale. If, however, the building
or improvement is sold within outs year of comp/etfon, 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. 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
1 Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.), .
Policy;No?� Ay lei af'r'1%pml>�y .r >�< .rte
Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be complated it 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
aliforniaDateOwner
NOTICE TO APPLICANT. If, after making thistio
Certificate of Exempn you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this venin shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is 3 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 whet property 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
No. 05773
BUILDING:'TYPE CONST.'
A.P. Number
,Legal Description IM 163
Project Description S.F.D.
OCC: GRP.
Sq. Ft. 1563
Size
No.
Stories
No. Dw.
Units
NeAN Add ❑ Alter ❑
Repair ❑ -Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk.'Dep.
2sci.ca.
Plan Chk. Bal.
239..07
Const.
Mech.
60.00
Electrical
:101.21
Plumbing
12060
S.M.I.
6.16
Grading
Driveway Enc.
Infrastructure
7.
TOTAL
$3,333.24
—J,
REMARKSn +an r�spi rt. s •; n can r..k A
°1;:_ 1,*993 .2 4 4 �
i
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property.Line
FINAL DATE INSPECTOR
Issued by: Date 5/18$ Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
�l
SLAB GRADE G '��
`
OF BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK/
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
S (ROUGH) ?� /Q�.
(((
ETER LOOP
HEATING (FINAL)
POWER OUTLET
DRAINS
GAR. SQ. FT. ®
TEMP. POLE
IROOF
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
=$
LUMBER GR.
FINAL INSP. 3/ J/ Q�
FRAMING (� Zq ���
URINAL
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
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
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
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
FINISHGRADING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 34c
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 PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
�l
SLAB GRADE G '��
ROUGH PLUMB.
OF BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK/
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. 21 (((
S (ROUGH) ?� /Q�.
(((
ETER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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. 3/ J/ Q�
FRAMING (� Zq ���
FINAL INSP.
ROOFING,l Q�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHINGVV t `eprf�
MESH
INSULATIONISOUND lel-
-FINISH
FINISHGRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL