03998 (AR)44Q
u & ,+ L!4- 4Q41N %,¢ ( P.O. BOX 1504
Buil78-105 CALLE ESTADO
re
Addss 78.040 V.; ` --':A , LA QUINTA CALIFORNIA 92253
Owner CAU-- M012-176
nT'T.T_ VAT T_ a
Address 78-044 VILLA VISTA ; r
City Zip Tel.
LA QUIRTA 92253 .-� ,
Contractor ,
T.A. MMY-WIT ,
A .i.i....... ./
Y 77-350MBA
City ]Zip Tel. 4
BAt . UI 92253 564-"60
State Lic. City
& Classif. B, 442118 Lic. #
Arch., Engr.,
Designer
Address Tel.
City :" Zip State
a,
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter g (commencing with Section'.
7000) of Division 3 of the Business and Professions Code, and rmy license is in full force and
effect. -"I cti g,.a.vf V _—
SIGNATURE a r• y DATE
OWNER•BUILDER DECLARATION
I hereby affirm that I am exempt from -the Contractor's License Law for the following
Treason: (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 applicant for such permit to file,�atsigned statement that he is licensed -pursuant to
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
for the alleged exemption. Any violation of Section 7031.5 by -'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (S500).
❑ 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 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.)
❑ 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of cons_ent,to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Pol'cy No. Company ,07'74 A., ...., .. ..c.r�i
�'"Copy is filed with the city. 0 Certified copy is hereby furnished:
CERTIFICATE OF EXEMPTION FROM '
WORKERS' COMPENSATION INSURANCE
(This section need not be -completed if the permit is for one 'hundred dollars is 100) 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 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
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 it work.thereunder is suspended for 180 days.
I certify 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
i +
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 769-023-013
Legal Description
Project Description EXTMM TA73'i1 G R0011 AMA
Sq. Ft. $ No. No. `Dw.
Size Stories Units
New ❑ Add O Alter O Repair ❑ Demolition O
� a
on 5772
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
36.72
Const.
�.
Mech.
Electrical
$C.t
Plumbing
S.M.I.
. `3
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
Y,Yr•f.•++t, • m-. .4.4...1 rt.F` eli
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback fro. -n Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR '
Issued by: Date Permit
Validated by:
Validation:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
�• } CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
N0. PLUMBING FEES .
tST FLtg SO FT (p _ .S t '• s.
UNITS
SLAB GRADE
2ND FL. SO FT. a
BONDING
YARD SPKLR SYSTEM
POR SO FT at
MOBILEHOME SVC.
BAR SINK
GARSO. FT. ra
POWER OUTLET
ROOF DRAINS
CAR P. SO FT. 9
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. @
..
DRINKING FOUNTAIN
' SO. FT. ra ..
TEMP. POLE
URINAL .
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
'-
4'
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 s "'
• -
SQ. FT. ® c
WATER HEATER '
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID 1'A c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR (g 3/4c
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
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
Y L'
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
'-
4'
REMARKS:
VENTILATION ..
-
FIRE ZONE ROOFING
FIREPLACE ..
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
/
FINAL INSPECTION/J : -
CERT. OCC. '
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
y
_y . .t�,,,'s �% � r ,, � . 4 ¢ f ... � r � � , ":. i'e � �r Y _*P r • -. , r,•` � •V � .�� ,
DESERT_SANDS'UNLFIED SCHOOL,DISTRICT
®�..
Q�����.�ipE Highway".11l , . ; ,• 35�� ,
�CTf�o�:: �� a Indio, „CA 92201°*� '�• ` �'y t
r
U
BE LIC �,r�{� D"
CERTIFICATE•OF`SCHOOL'FACICI.TY.-.FEE'WAIVER - r
r TO: ,DATE •
C � I
This. i sto certify tha ,
t - developer of ' _t, ` ;which is .�
M _ tlocated; at, w,ithin�.f '
t
this school di str.i ct,' is not; require to ,pa school f ci i ty zees
pursua6t'Ao the author,'ity generated .bytGovernmentr,Code',Sect„i'on 53080..
,.Building :permits. for''the'-project i ndi cated�.ab'ove .may now'be, •i ssued by.-your f .
_ ' ju_r_i,s-di.c—ti-on-:� IF VALUATION INDICATED ON BUILDING PERMIT EXCEEDS$20,0s• . ,
THIS WAIVER IS VOID AND A SCHOOL FA ITIES FEEMUST BE PAI PRIOR TO
ISSUANCE OF BUILDING PERMIT.26 -y ••
- fo DESERT.'SANDS NIFIED SCHOOL DI'S'TRICT.
•. F'
} �< Al 6e-Building Department Yellow-Facilities Pl 4nning Pink-Developer (10)-33 1'
'' ��t�:.. _ _ �. ."• '+rte' _'t_ r t •