05091 (SFD)Building
Address 54 -
Owner g
Mailing
Address
City v
Pala DQaS
Contractor
Address
C � tA+sq
City
1'4 1
j P.O. BOX 1504
78-105 CALLE ESTADO
501 knverneas LA QUINTA, CALIFORNIA 92253
V4
State Lic.
& Classif. 288130 -
Arch.,
$8150'Arch., Engr.,
Designer
Address
City lZip
I. LICENSED CONTRA
No. 05091
A M
BUILDING:, TYPE CONST. OCC: GRP.
A.P. Number
�,•�$ Legal Description
Project Description Plan 9NR
Tela - "
City
Lic. # 328. _ Sq. Ft.:, 2489 No., No. Dw.,
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel.
State
Lic. #
IATION
I hereby affirm that I am licensed under provisions of Chapter 9.(commencing with Section
70pp) of Division 3 of the Business and Professions Code, and my license is in full force and
4� effect.
SIGNATURE - - DATI
OWNER -BUILDER DECLARATION'
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usrness 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 Permit to We a signed statement that he is licensed pursuant to
the provisions of the Contractors 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
subjects the applicant to a c" penalty of not more than five hundred dollars (8500).
❑ 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. If, however, the building
or improvement is sok) 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.)
❑ 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 contrac(ors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec- B. g, P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I her 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 company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKED' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) 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 Califomia.l
Date ` ' -''`Owner 1 `�
NOTICE TO APPLICANT. N, after making --Oris Certificate of Exemption you should become
subject to the Workers' Conversation provisions of the Labor Code, you must forthwith
comply with such provisions er this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a constructionlending agency for the performance of the
work for which this permit is issued. (Sec. 3097, C40 Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity that 1 have read this application and state that the above inform ion is correct.
I agree to comply with all city and county ordinances and state laws relati to building
construction, and hereby authorize representatives -of this city to enter 'he above-.
mentioned property for inspection purposes.
Signature of applicant Date -
Mailing Address
City, State, Zip
stimated Valuation
$170,2Q$
Minimum Setback Distances:
. PERMIT
Front Setback from Center Line
AMOUNT
Plan Chk. Dep.
Side Street Setback from Center Line
Plan Chk. Bal.
Side Setback from Property Line
$ 500.90
Const.
INSPECTOR
610.50
Mech.
Validated by:
3 300
Electrical
13,52
Plumbing
1 AD
MAD
S.M.I.
1
Grading
p~
Driveway Enc.
Infrastructure
$31, 929.6$
1,9t4.84
a, ft Cre-Alt
1.914.R4
TOTAL
a�,295'.7Ci
` ..7C—;,
REMARKS w,
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:
12/27/8$
Date Permit
Validated by:
t
Validation:
,y CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (RO H)
DRAINAGE PIPING
CARP. SQ. FT.
OTHER APPJEOUIP.
REINF. STEEL
WALL SQ. FT.
TE . POLE
DRINKING FOUNTAIN
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
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
REMARKS:
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.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® Vic
HOUSE SEWER
MESH
ze
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
EWER ORSNK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (RO H)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
AS (FINAL)
TE . POLE
GROUT
WATER HEATER
ERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus -x$-=$
LUMBER GR.
FINAL INSP.
ING
FINAL INSP.
WOOFING �iLsj
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
R. FIREWALL
/
LA C Z
MESH
ze
NSULATION/SOUND 5'
FIN H GRADING
AL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL