15002 (AR)e
P.O. BOX 1504 No. 15002
Bttaiding �, A� r 78-495 CALLE TAMPICO
Address i l)- —665 �� + �� f :;eT:-.� LA QUINTA, CALIFORNIA 92253
Owner . ,
Vial.�.ar .'i..�.,t�a._.I,l
Mailing
Address sz:fn .
CityZipTel.
'teQ�z .,r. , u), 92253 :77 -3„sbl
Contractor
Erellenbk rc er A�r>>��., Zrir..
Address I
City Zip Tel.
State Lie.
& Classif. -B 4:9 P 2 3 4
Arch., Engr.,
Designer Ait°i"iai fa Nullec:k
Ardciress
.31,
Lie. # 1958
Tel.
City I Zip State
Lie. #
LICENSED CONTRACTOR'S DECLARATION
herab affirm that 1 am licensed under provisions of Chapter 9 (Mmmencing with Section
of iivislon 3 of the Business and Pr6lessions Code, and my license is In full force and
four.
NA DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sea. 7031.5.Busfness and Professions Cade: Any city or county which requires a
permif to construct, alter, in orova, darnollsh, or repair any structure, prior to its issuance also
requires the app$canl far such pem* fa fle a signed sfafament thal h. s licensed pursuant to
the provisk)ns of the Contractor's Licansa Law, Chapter 9 (commencing with Section 70001 of
DW,dan 3 of the Business and Profassions C:ado, or that he is exempt Ifterefmm, and fhe basis
for the aNegad axomplipn. Any vfalaflon of Secfkm 7037.5 by any appflcanf lot a permit
subjects the appkcanf to a civil penalty of riot more than five hundred dollars (S500).
L I, a$ owner of the property, or my employees with wages as their sole compensation, w111
do the work, and the structure is not intended or offered for sale. (Sec. 7044. Bussness and
Professions Code.- The Contractors License Law does not apply to an owner of property who
builds or improves Mereon and who does such work hknseff or through his awn ampioysas,
provided that such improvemants are nor intended or offered for safe. 11, howavvr, the buildJng
or krWovemenf is sold wifhkt one year of comoution, the ownar•buMor wfil 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 consent to self -insure, or a certificate of
Worker's rearn pen sation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
PolEcy'no. Company
Copy is filed with the city. ❑ 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 ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any pperson in any manner so as to become subject to the Workers' Compensation
Laws of at ifomia.
Date —Owner NOTICE TO APPLICANT: if, after making this Certificate of Exemption you srcuirr becom—e
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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 informatlon Is correct.
I agree to comply with all city and county ordinances and state laws relating to building
cpmstru ction, and hereby authorize rapresentativas -of this city to enter the above -
mentioned property for inspection purposes.
Signature of applicant
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. OCC. GRP,
A.P. Number
Legal Description
Project Description Bonus Rocmi
Sq. Ft. No. No. Dw.
Size ? 50 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $5 r ?05 . 00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
52.65
Const.
81.00
Mech.
15.00
Electrical
20.25
Plumbing
S.M.I.
r�
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from CP erne
Side Setback from Prc* Line
FINAL DATE INSPECTOR
,r 1
Issued by: Date �_Permit
Validated by:
Validation:)
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
$
UNITS
1ST FL. SQ. FT a
YARD SPKLR SYSTEM
2ND FL. SQ, FT c�
IMOBILEHOME SVC.
BAR SINK
POR. SQ. FT. rig
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
DRAINAGE PIPING
CAR P. SQ. FT.
DRINKING FOUNTAIN
WALL SQ FT. @
URINAL
SQ. FT
WATER PIPING
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
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
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
POLE,TEM/PERM
LAVATORY
COMPRESSOR HP
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® Vic
HOUSE SEWER
GAS PIPING
ERMIT FEE
PERMIT FEE
PERMIT FEE
BL TOTAL FEES MICRO FEE
I
MECH.FEE
PL.CK FEE CONST. FEE
ELECT FEE
SMI FEE
PLUMB. FEE
STRUCTURE
SETBACK
SLAB GRADE
FORMS
FOUND REINF
REINF. STEEL
GROUT
BOND BEAM
LUMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
PLUMBING
GROUND PLUMBING
ROUGH PLUMB.
SEWER OR SEPTIC TANK
GAS (ROUGH)
GAS (FINAL)
WATER HEATER
WATER SYSTEM
FINAL INSP.
ELECTRICAL
UNDERGROUND
BONDING
ROUGH WIRING
METER LOOP
TEMP.POLE
SERVICE
HEATING & AIR COND
A.C. UNIT
HEATING (ROUGH)
DUCT WORK
HEATING (FINAL)
FINAL INSP.
GRADING
FINAL INSP. cu. yd.
$ plus x$
REMARKS:
SOLAR
COLL. AREA
STORAGE TANK
ROCK STORAGE
OTHER APP./EQUIP,
EE
GARDEN WALL FINAL
-z,.-
IYV�'-L:J-7v GIU INTA BDLG &: SAFETY 6195648487
P- 01
Certificate of Compliance: ResIdentla� (Page 1 of 2) CF_1 R
r,vrwT� (o iris__ F !
Project Aadream
c_� — 3 elept►orne
evcumtlan avtho� I
Cotnptfance Welhod (Package. Point S�rsrem w Cornpuklr) glenpte Zor►e
GENERAL INFORMAT1014
Total Co nditio ned Floor H re a:
Building Type:
(ch&t ano cr morel
Front bnenls1kN1: °
Number of Dwelling Units
Floor Construction Type:
f 57) it,
Single Family Addrtion
Muttl-Famity Exlsiing-Pigs-Addtlon
Norlh 1 East 1 SOUth7we-169 RA OrletttationS
(Input okntal3on in derma Ode ano.)
Slab I Raisod Floor (circle one or bath)
BUILDING SHELL INSULATION
B,iiiding Permit
Plan Check / babEl
FEttld Check) ❑ads
Enforcement Aaency Llsooniv
Construction
Component insulation Assembly Location/Comments
Type, R-Value U-Vabe attic, to qarago, typical, atc.
Wall .............
Wall .............
Roof .............�-
Rool............. — -
Floor .............
Floor............. —
Slab Edge _... � A - - - - - --
FENESTRATION Shading Devices
Fenestration Area Fenestration Interior Exterior Overhang Framing Type
0fienlation (,f) U-Value mller bind, etc_ sttadescreen, etc. eslrara rstata3,43odNin if
Front,._.. { ✓j � 5 • 7 S
Front.._-- ( 1
Left ....... (✓) �� s
Left -------
Rear__-
Rear
Right.....
Rlght...-- { ) -
Skylight .......
Skylight .......
THERMAL MASS
Type/Covonng Area Thickness
(slablaq nscd, Lib, etchL inches LocationiDescrl Mon rtrhen. bath, etc.
Rain-.d January IN07 Q 1 COO/
,!ON-23-54 WED 15:54 LA QUINTA DDLG & SAFETY 6195648427 F_A2
Certificate of Compliance: Residential (Page 2 of 2) CF-y R
r�rn}eel 71tb Dal* ---
HVAC SYSTEMS
Now Input hydranic or combined hydroric data under Water Heating Systems, except Design He" rig Load -
Distribution
Heating Equipment Minimum Type and Duct or
Type (furnace, heat Efficiency Location Piping Thermostat
pump, etc.) (AFUEIHSPF) (ductshMic, otr;.) A -Value Type _
_EJx 15 7-1 A.L6 _ N .tA
Cooling Equipment Minimum Duct
Type (air conditioner, Efficiency Location Duct Thermostat Configuration
heat pump,_evap. aoofina _ (SEER} 1altic etc. R-Value T e (split or package)
N/A_ --
WATER HEATING SYSTEMS
Energyl Extemal
Hated' Tank Faclor or Tank
Water Heater Distribution Number input (kW Capacity Recovery SWnclbyi InsulMon
Type Type In System or Btu/hr) (gallons) Efficiency Loss (/o) R-Value
GKr S-rr�6 NIA
1. For amatl gas sicrrae (ratad input 5 75,000 Btuehr), nkrelrlc makience and hW pump Wstar haattera, fist Energgyy Frcior-
Far tarps pax aw-ve water hCowe (rated inpul �- 75,000 andrtw), Ifni Ralad 1"p P.&Wvgry Efficiency end Standby Loos.
For inmtantanaous pea Yr&W b0*1*rf, fist W&d fnptA and Recovery Efkienuy.
SPECIAL. FEATURES/REMARKS (Add extra sheets if necessary)
CO11i1PL1ANCE STATEMENT
This oerfific& of compiiance lists the bulldIng lectures and perlomiance spedicatiaris rlt stied to compb v#th Tr<la 24, Parts t aid 5, of
Ow California Cade of Regulations, and the administrative regulations [v implement them. This cetrrate has been sigroed by It*
indMdual with overall drlsign respanslbllity. When this tor]iWte of oompiiarw is submitted for a stele building plan to be bull in mulfiple
oiientafions, Any shaci g lealum thatis varied is lndicaled in tN Spedci1 FAatura Ramarks section_
Designer or Owner (Far euatneas & Pmfssslans Code) Documentation Author
Narr.rl: �p 6r✓fL Si-- - �EEa jASSot.,-Xr eNartta:
Trde/Firm O TiSBIFirm:
Address: re Address:
cr2a'- CA. 9221 t
Telephone: ( 6o (9 -7-7 -7 — -7 -7 Ln (o Telephony:
Gr��dG Tr �
Lk:- 4-
c--
(6igna4rrg) (data} {rrenature} �}
Enforcement Agency
Name:
Agency: J
Teiopf)one _
(sigroWra/stamp)
P,*vf"d January 11m
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