04976 (SFD)Building
Address
Owner
Mailing
Address
City
Contra
Address
City
State Lic.
& Classif_ 288130
Arcl>_, Engr_,
Designer
Address
P.O..BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
ILDING: TYPE CONST
No. 04976
_OCC: GRP.
'41f.0 2AAA.P..Number
•2 Legal Description
468 .42k
Project DescriptionPhali c! -266 Puts 30H
Tela
r^w
City
Lic. # 3 2 i ... a il Sq. Ft.
SiZf -1. 1
Tel.
CityIZIp I
State
Lic. #
+ t N3 NSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7D00) of Division 3 or the Business and Professions Code, and my license is in full force and
effect t ./s. r f. i : •' _ s' A
SIGNATURE - DATE
OWNER43ULDER DECLARATION -
1 hereby affirm that 1 am arenpt from the Contractor's License Law for the following
reasort (Sec. 7031.5-BuShess and P►ofessivs Gude: Any cdy or county which requires a
permit to coristruct ata, -puff danoI f or repair any structure, prior to its issuance also
regries the appfcaf for such permit to He a signed statement that he is licensed pursuant to
the proveus at the Coubac0aft license Lar., Chapter 9 (commencing with Section 7000) of
4visan 3 of the Business and Pn*essrs Code, or that. he is exempt therefrom, and the basis
for the alleged e==PGon. Any v- 11i n of Section 7031-5 by 'any applicant for a permit
sutjeds the app I I b a cidperrdy atnot more than five hundred dollars ($500).
Cl 1, as owner of the properly, or my a rtend es with wages as their sole compensation, will
do the work, and the sbucbre is not intended of offered for sale. (Sec. 7044, Buisness and
Pmfessm= Code- the Coebacl!" License Law does not apply to an owner of property who
brills or Ruptures 9tenwo and who does such work himself or through his own employees,
provided that lurkirnpovema� are not krarded o offered for sale. If, however, the building
Or h4-3031 is soldwuNner one year d completion, the owner -builder will have the burden
otpvouft that he did nun hum or improve for the pupase of sale.)
❑ 1, as owner of the properly, am exclusively contracting with licensed contractors to con-
struct the project (Sec 704.4, Ekm*w s and HaRessions Code: The Contractor's License Law
does not apply to an owner of property who brill or irproves thereon, and who contracts for
such, li Is wnib a ewnackoN Ecersed pusuad to the Contractor's License Law.)
❑ 1 am exempt under Sec a ti P -C. for this reason
Date Owns
WORIaW COtffE31SATION DECLARATION
1 hereby affinm brat 1 have a certificate of consent to self -insure, or a certificate of
workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Polity No _.Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTHWATE OF EXEMPTION FROM
1111H S' COMPENSATION INSURANCE
seck'on need not he oorrpie1 i the permit is for one hundred dollars ($100) valuation
I certify that in the performance of ft wank for which this permit is issued, I shall not
employ any person in awry Runner so as to become subject to the Workers' Compensation
Lams of Cati(anma
Date-.�Onla� .
NOTICE TO APPLICANT: I, afler g ihs Certificate of Exemption you should become
su*ct b the warters' CooPansadwn provisions of the Labor Code, you must forthwith
ewnp/y wdh such prwftos o Oirpermt shat be deaned revoked.
CONSTRUCT10N LEADING AGENCY
wokhereby att� that there •s a corsbuction lending agency for the performance of the
for WIW permit is issued (Sec- 3097, Civil Code.)
Lenders Nelle
Lenders Aridness
This is abmmildng pennil -heron properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
1 certify that 1 have read this application and state that the above information is correct.
1 agree to comply with aN city and county ordinances and state laws relating to building
ioconstrupr
fives of this city to enter the above
for inspection purposes.
Signe of applt Date
Mailing /Wdress
City, state zip
2825 No., No. Dw.
S 1; A Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
*194,692
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
9 55 S . 11)
Const.
A70 50
Mech.
-
00
Electrical
?
Plumbing
iA 0
S.M.I.
2
Grading
Driveway Enc
Infrastructure.44
2.190.29
TOTAL
$3,742.72
REMARKS
2ti L•If:;rt L lxrrtti_ a ...:.. r c
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 12/8/8 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.� SQ. FT. @ $
UNITS
COLL. AREA
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
OR SEPTIC TANK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. SO. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
WALL SQ. FT.
DRINKING FOUNTAIN
TEMP. POLE
URINAL
SO FT ®
HEATER
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$plusx$=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
�FG f
I:NG
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.
SQ. FT. @ c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
ING
SQ.FT.GAR ® 3/ic
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
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
OUGH) ,'4
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
*AS
INAL
TEMP. POLE
GROUT
HEATER
ERVICE 7 `
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$plusx$=$
LUMBER GR.
FINAL INSP.
NG ji
FINAL INSP.
�FG f
I:NG
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
G R. FIREWALL
ING
MESH
NSULATION/SOUNDZ7
[[
FI H GR DING
AL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL