003229 (SFD)Building 54-812 Xnvemda6
Address
Owner
4 4
tyl QUAA.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QU�INTA, CALIFORNIA 92253
mailing I
Address iw-fAl ["tatxtf-rs:<:�?� kips,?
City I Zip ITel.
Contractor '
Address
No. £03229
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number Pfd Wii*at
Legal Description
Project Description Tjhx*ga, 21A1?+l r*�It 14t�T
-,city
Zip
Tela "
Distances:
State Lic.
& Classif. 228130
City
Lic. # 328
g33Q
Sq. Ft. No.
Size GAR. 424 Stories
No. Dw.
Units
Arch:, Engr., -
Designer
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Address
Tel.
INSPECTOR
Issued by:
City.
Zip
State
Validation:
Lic. # -
f LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is -in full force and
effect. r.;f. �• % '11 "lt/.!'_.rY_., %'/%✓-7
SIGNATURE`'' --" eDATE
OWNER -BUILDER DECLARATION
I 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 .
.- r permit to construct, alter, improve, 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 Jo
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000). of
' Division 3 of the Business and Proldasions 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 civil penalty ofnot 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 is 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 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 sold 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.)
Estimated Valuation
$94,244.0 0
• ,
PERMIT � � � -
-
- AMOUNT
Plan Chk. Dep. -
,.
-
Plan Chk. Bal.
C 1 AA €'F
Const.
Al � A
Mech.
-
1 A Do
Electrical
Q C1 Q '
Plumbing
07
❑ 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 or property who builds or improves thereon, and who contracts for
such projects with a contra ctor(s)dfcensed pursuant to the.Contractor's License Law.) '
. O. I am exempt. under Sec. B. & P.C. for this reason
T S.M.I.
_
Grading
_
Driveway Enc.
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. Company "
❑ Copy is filed.with the city. ❑ Certified copy is herebyfumished.
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.) - -- -
1 certify that in the performance of the 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: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY.
Ihereby 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
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 certify that I have read this application and state that the above information is correct.
1 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
HARD COPY
Infrastructure 1
TOTAL A1 .5 r,
REMARKS s to `jj _e y /
-N T 4V1 Tie,
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 7 /7 0; /R'Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO, FT, ®
CAR P. Q. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
OUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
S (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
_$
LUMBER GR.
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 PLU BI GO/57
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 8 Zo O
OUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC A K ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. '
S (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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.
FRAMING1026 07
INAL INSP. 4e�10'
ROOFING �p /�
✓ ,
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r v �i
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ry
Lam'
REMARKS:
VENTILATION
FIRE ZONE ROOFING =
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING d /l �✓ lI 6 Q/
MESH
INSULATIONISOUND `D '
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL