003894 (BLDG)4
P.O. BOX 1504 No. 003894
Building 49--439 Eisenhowdr LA QUINTA, CALIFORNIAAddress 92253
Owner
Crico of Palm Sori.ng8 BUILDING: -TYPE CONST. -OCC'. GRP.
Mailing
Address 1 - 200 Rockville Pike A.P. Number 631-370'°-021
City Zip ITel,
�� �iki52 30,M20 Legal Description
Contractor Project Description Bell Yian t n Buiidincr
Add1rress a, r�rxa ?r 7.a,ra t'nxm ct4 a^•� { aca .. ... .
P. O•• BOX 1000
City Zip' - Tel.
T.fa mit. + 92253 345-2988
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr.,.
'49 � � �' Size • 875 Stories_ Units
._ .
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
� LICENSED CONTRACTOR'S DECLARATION
1 herebyy of ffirm that;l am licensed under, provisions of Chapter 9 (commencing with Section
7000) of'Division 3 of the Busines(s and ProfestsionsyjCjo—de, and my license is in full forceydnd ,
effect/1Mt •�„^`\... ! r t [' t�r. .,ti�7_ �.R {.
SIGNATURE ..7.'l _ K. ih 1%14 I Ar'. `�' tDATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the followingts�. 67
reason: (Sec. 7031;5,Business and Professions Code: Any, city or county which requires a +wry d.44�t .
permit to construct, alter. improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant'for such permit to file a signed statement that he is licensed pursuant to PERMIT '
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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). -
0 I, as owner of the. property, or my employees with wages as their sole compensation, will Plan Chk. Bal. '$
71.22
do the work, and the structure is not intended ofoffered for sale. (Sec. 7044, Buisness and CDnst. �'�, �
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, Mech.�
provided that such improvements are not, intended or offered for sale. If,, however, the building
.50
or improvemenf 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 or sale.) ti
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con Plumbing
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 S•M•1• .�
such projects wither contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. 8 P.C. for this reason Grading
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate 'of consent to self-insbre,'of 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. O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS -
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation s O"t 4 (S 004 A 11A _ 7/._ Of.)
or less.) t l) . GH., ii 1 t 01 Ni. I :,'v
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 ZONE: BY:
subject to the' Workers' Compensation provisions or the Labor Code, you must forthwith Minimum Setback Distances: ' comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from. Property Line
Lender's Name -
Lender's Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to t *tl
expiration if work thereunder is suspended for 180 days. 6 `8
1 certify that I have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL. SQ. FT.
FOR. SO. FT. ®
GAR. SQ. FT, ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ. FT. ®
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,TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a 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
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.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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
(/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL