04833 (SFD)OWL
4 4
041e3
P.O. BOX 1504 'IAN ADEQUATELY SIZED DEBRIS CGZ;AiNE .
Building 55-455 pebble B aCh LA QUINOTACCAL CALIFORNIA 92253 �� REQUIRED ON THE JOB -SITE DURING
AddresOwners ALI £'HASPS OF CONSTRUCTION
1iChael tlrajr
Mailing
BUILDING: TYPE CONST. OCC. GRP.
Address $5 Emerald say A.P. Number 769-360—OOH
City Zip Tel.
La9tina Beach 92651734-494roi7S5 Legal Description
Contractor �.;�' cCf �ftf� Tf !f l?�"`11��9 %+!L Project Description `��•+'
Address
Pity p r Zi
i',,a7. ?. (, / Tel I 1f
State Lic. City
& Classif. . /u Lic. #127-1 Sq. Ft. No. No. Dw.
r
Arch., Engr., Size 6008 Stories Units
,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
Pool t Spa and perimeter walls not
City Zip State included in this permit #
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am Ilcensed,under provisions of Chapter 9 (commencing with Section
7000) of Diviision 3 of the Buslness'�arn-d Professions Code, and my license is in full forc . and
effect. 7! ✓-"4Rip'N /' +✓� ��r f it a7,!�?�"
SIGNATURE' DATE
OWNER -BUILDER DECLARATION Estimated Valuation $429,.682
I hereby affirm that I am exempt from the Contractor's License law for the following
reason: (Sec. 7031.5,9usiness and Professions Code: Any city or county which requires a
permit to construct, atter, 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 to PERMIT AMOUNT
the provisions of the Contractor's 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 2250.00
,, ^
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep. ,a 5 V • 00
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. BBI. $ 774.59
❑ 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 CiOTISt. V�
Professions. Code: The Contractor's License Law does not apply to an owner of property who 4
builds or improves thereon and who does such work himself or through his own employees, MBCh. 8�y�qf KhAM
provided that such improvements are not intended or offered for sale. If, however, the building iJ i • tJ V
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical�-
of proving that he did not build or Improve for the purpose of sale.) •
45
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing Z Z O • UQ
slruct 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 S.M.I. • ry
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
D I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of1consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a cert' hied coWthereof. (Sec. 3800. Labor Code.)
Policy No. .Company ( + p i -
❑ Copy is filed with the city. ❑ Certifled copy It hereby furnished.
TOTAL t ♦ . �.
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.)
I 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, alter 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
I 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.)
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 car lfy 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
REMARKS
+tt;.i i Cis Y1`i` "r►44
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 Permit
Validated by:
Validation:
1
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY -. FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL- 50 FT !p S
UNITS
"
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. C
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. at
GAS (ROUGH)
METER LOOP
GARSO. FT. kf
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO FT. a
GROUT
WATER HEATER
WALL SO. FT. Q
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. 0
_ S
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP. /y�
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
IKITCHEN 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. g c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 1'A c
SEWAGE DISPOSAL
SO.FT.GAR @ 3i c
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE bL.CK.FEE 77
ELECT. FEE
SMI FEE PLUMB FEE1 1
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
y _plus -x$
_ S
LUMBER GR.
FINAL INSP. /y�
FRAMING
FINAL INSP.
R OFING
PVWRl �� 5��5
l�
cel /1 W 16/71
� _ i
REMARKS:
VENTILATION���
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
AR. FIREWALL
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
i�
CERTIFICATION OF PAYMENT
OF
OTICEa SCHOOL FAC LITYFEES cW
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that
developer of r 4which is
located at within
this District, has paid school facility fees imposed pu_sua t to the
author'ty genera"by overnm nt C d Sectioli 53080 in th ampunt of
covering a total of J square fee-tkqf ( residential or
( )
industrial/commerciA development and that building permits for
this footage in this development may now be issued by your jurisdiction.
,06,q tAE5 - - -m--i;r- 14
--O- t�N- Liiz k1f
for DESERT SANDS UNI IEID SCHOOL DIrSTRICT
016f+ + 0/t (Cl U^'A -"
White - Building Department • Yellow - Facilities Plan ng • Pink - Accounting VGold - Developer
0007