06670 (SFD).14f 4 4 a"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 78-7A5 31illok a p r IVR LA QUINTA, CALIFORNIA 92253
'£rr1,ad Peci f.`ie Desert Div.
Mailing
Address 74-923 Abv a 0130
City Zip Tel.
Pali Demrt 1.92260 34"174..
Address
Zip Tel.:
State Lic. I City
& Classif. 505699 Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSEUCONTRACTOR'S DECLARATION
I hereby affirm tha$,1 amain' licensed. under p!o0sions of Chapter 9 (commencing with Section
7000) of bfvl"sion 3;of the Business an�dd,Professidns Code, and my license is in full force and
effect
SIGNA_TUBE•% / 4— t' Y.. YDATE
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's 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 appbcant for such permit to Me a signed statement that he is licensed pursuant to
the provsions of the Camractors 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
suNects the applicant to a civilpenalty of nai more than five hundred dollars ($500).
❑ 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 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. If, however, the building
or brprovernent is said 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.)
❑ 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 bunds or improves thereon, and who contracts for
such projects with a cont actors) licensed pursuant to the Contractor's License Law.) !
-❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owrier
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3900, 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 it the permit is for one hundred dollars ($100) valuation
or less.) .
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
N077CE TO APPLICANT: A, after making this Certificate of Exemption you should become
subject to One Workers' Compensation provisions of the Labor Code, , you must forthwith
cmpy wfth such provisions or this permit shalt 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.) .
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.
1 car tity that 1 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. 06670
BUILDING:. -TYPE CONST. OCC: GRP.
A.P. Number La Quinta-kWh1auds TT 23269
Legal Description
Project Description
SPS Plan C-R Lot 157
Sq. Ft. 1563No.
-Size
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ .
Repair ❑ Demolition ❑
Estimated Valuation
$87,591
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 489.07
Const.
585.50
Mech.
60.00
Electrical
_101.21
Plumbing
120.50
S.M.I.
6.16
Grading
Driveway Enc.
Infrastructure
1,970.80
TOTAL
3., 333.► 24
s
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
11lr7/f�9
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE C Z
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT, ®
S (ROUGH)41'T �v
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL SO. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
SO FT ®
FINAL INSP.
FRAMING3 / ��
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
LAUNDRYTRAY
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 ® 3/4c
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE 7ONST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBI G O
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE C Z
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.'.L
S (ROUGH)41'T �v
METER 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.
FRAMING3 / ��
FINAL INSP.
ROOFING
ROOFING
S ! v /4
/
/
C/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTORA
GAR. FIREWALL
LATHING .]
MESH
INSULATIONISOUND
`
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINRIALS
'
GARDEN WALL FINAL