12972 (SFD)1Sep
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address ` �F� ''`-'-��';� LA QUINTA, CALIFORNIA 92253
Owner
dui '3' i.!.,LLrs
Mailing
Address % , i . 710- .�
City JZip Tel.
Lit QU-1'.1'' --., CA 9' 5 > 3 6 4'-- 4, ` 3 ,
,
Contractor
S-aT•,-!�
City lZip ITel.
State Lic. r, City -,
& Classif. 4 8 7 5 `1 4 Lic. # 26
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
fj LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that�l am licensed yt�%der provisions of Chapter 9 (commencing with Section
7000) of Division 3 o(the Business anti Professions Code, and my license is in full force and
effect. I _ —
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the contractor's License Law for the following
reason: (Sec. 7G37.5,Busin6s9 and Professions Code: Any oily or county which requires a
permit to construct, allor. improve, demolish, or repair any struclum, prior to its issuance also
requires the applicant for such permll to We a signed statement that he Is licensed pursuant to
the pmvf5lnns of the Contractor's License Law, Chaprar 9 {commencing with Section. 7000) of
avlsion 301 the Business and Professions .Code, or that. he Is exempt rherafrom, and the basis
for rho alleged exemptron. Any vtolalfon of SocIton 7f137.5 by any .applicant for a perrnll
smwects the applicant fo a clvii panarfy of oat more than live hundred dollars {5500).
I- I, a5 owner of the property, or my employees with wages az their sole compensation, will
do the work, and the structure Is not intended or offered for sate. (Sec. 7044, Sussness and
Professions Code: The Contracfor'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.
pravided lhaf such lmptovernenls are not intended or offered for sale. If, however, the bultding
or !mprnvemenl is gold Wifhkl ono year of complefiwr, 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 Profes"ns 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.)
❑ I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMP SATION DECLARATION
I hereby affirm that I have a certliic to of consent to seliinsura, orp. certificate of
Worker's Compensation Insurance, or a ce 'rf rid co p!..+Saa366�-teadt Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Cert ied 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 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: 11, 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 if work thereunder is suspended for 180 days.
I certify that I have read this applicatlon and state that the above information Is torrent.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize Topresentatives of this city to enter the above•
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address _
city, State, Zip
No. 12972
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 7r.P
Legal Description z _ -,4 ',r "Dub .r']-a:_
Project Description
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New Ik Add ❑
Alter ❑ Repair ❑ Demolition ❑
P k+ .1!iw �.; ii'..�iljli..�f
6 r �: -._. ck
'.,7'31 ��. .. ...
Estimated Valuation
.P1? 3; 1.77 .
00
PERMIT
AMOUNT
Plan Chk. Dep.
2 , 01.
Plan Chk. Bal.
328.09
Const.
Mech.
64 2 Grp
Electrical
Plumbing
14 4 , 00
S.M.I.
Grading
_; 00
Driveway Enc.
-•• �i
Infrastructure
2,365.23
n Pu
i' r'<::
32.94
TOTAL
4,0.9.39
3,739..39
REMARKS
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
Validati
f CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL SQ. FT @
2ND FL SQ. FT. nn
POR, SO. FT. @
GAR. SQ. FT. n
CARP SQ. FT @
WALL SQ. FT. r@
SQ. FT. g
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
WATER PIPING
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
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
i
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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
r �
GROUND PLUMBINGSfj?/y
(jOJNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
FOUND. REINF.
SEWER OR SEPTIC TANK
f
GAS (ROUGH) 9 Jas�3 /n
J
ROUGH WIRING
METER LOOP
DUCT WORK
HEATING (FINAL)
ROCK STORAGE
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu.yd.
$ plus x$
_$
LUMBER GR.
FINALINSP. �O�J
FRAMING 17-3 -e
FINAL INSP.
i
ROOFING %// - .-?,I Lp
�r�iy' LLn
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATH NG % -! -9 3 C•IO
MESH
INSULATION/SOUND-
FINISH GRADING
FINAL INSPECTION —'&
CERT. OCC.
FENCE FINAL
INSPECTOR'S SFGHATURESIfNITIALS
GARDEN WALL FINAL