04848 (SFD)Tiht 4 a(P Qum&
Building
Address
Owner
73-067 Sari Tim teo
Mailing
Address 1) 0 (j '
City Zip Tel.
Contractor
17
Address
City l Zip
State Lic. - - City
& Classif. �S> '" Lic. #
Arch„ Engr.,
Designer
Address j Tel.
P.O. BOX 1504 "AN ADEQUATELY SIZED DEBRIS CONTAINER
LA QUINOTACCAL FORNIA 92253 IS REQUIRED ON THE JOB -SITE DURING
ALI. PHASES OF CONSTRUCTION"
BUILDING: TYPE CONST. OCC. GRP-
A.P. Number 61.7-334---105
City _ I
Zip +State
JI Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
^In NATU E _ DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, 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
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 ($500).
❑ 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
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 conlraclor(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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
O Ns section need not be completed if the permit is for one hundred dollars ($100) valuation
or Tess.;
I certlfy that In the performance of tng work for which this permil Is issued, I shall not
employ any person In any manner so as to become subject to the workers' Compensation
Laws of Caflfornla.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Cwnpensaflon prevlsiarts of the Labor Code, you must forthwith
comply with such provisions or this pamtn shoe be deiitised 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 Nam"
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 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 Hof this city to enter the above.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Legal Description_
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Days not
J
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep-
Plan Chk. Bal.
COnst.
Mech.
Electrical
Plumbing
S.M.I.
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 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
1ST FL
SO FT V.
2ND FL
SO FT a
POR
SO FT a
GAR
SO FT *
CAR P
SO FT a
WALL
SO FT a
SO FT 0
ESTIMATED CONSTRUCTION VALUATION
NOTE- Not to be used as property tax value
MECHANIC
VENT SYSTEM FAN
EVAP COOT
APPLIANCE
FURNACE UNIT WALL FLOOR
AIR HANDLING UNIT
ABSORPTION SYSTEM
COMPRESSOR
HP
HEATING SYSTEM
FORCED
BOILER
B.T.0
MAX HEATER OUTPUT, B T U
PERMIT FEE
DBL TOTAL FEES
ESTIMATE
$
NO
ELECTRICAL FEES
UNITS
MOBILEHOME SVC
POWER OUTLET
NO
I
PLUMBINr,- FFES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
is
WATER PIPING
ion
FLOOR DRAIN
IL FEES
WATER SOFTENER
HOOD
SIGN
WASHER(AUTONDISH)
DRYER
GARBAGE DISPOSAL
SUSPENDED
LAUNDRY TRAY
KITCHEN SINK
CFM
BTU
P
TEMUSE PERMIT SVC
WATER CLOSET
POLE, TEMIPERM
LAVATORY
3RAVITY
AMPERES SERV ENT
SHOWER
SO FT c
BATH TUB
SO FT. ®c
WATER HEATER
SO FT. RESID (a 11/4 c
SEWAGE DISPOSAL
SOFT GAR( �V.c
HOUSE SEWER
GAS PIPING
PERMIT FEE
I PERMIT FEE
MICRO FEE MECH FEE
PL.CK FEE CONST FEE
ELECT FEE
SMI FEE
PLUMB
FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND SOLAR
SETBACK
,i3ROUN❑ PLUMBING N
�� UNDERGROUND
A.C. UNIT COLL AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH) STORAGE TANK
FORMS
a
SEWER OR SEPTIC TAN
ROUGH WIRING
DUCT WORK ROCK STORAGE
FOUND REINF
GAS (ROUGH) Tyr
R LOOP
HEATING (FINAL) OTHER APP IEOUIF
RFiNF STEEL
GAS (FINAL)`G�
P. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP
BOND BEAM
WATER SYSTEM
GRADING
ru yd
$ plus x$ =S
LUMXER GR
FINAL INSP %Z/
r
FINAL INSP
REMARKS:
OFING
I
VENTILATION
FIRE ZONE ROOFING
SPARK ARRESTOR
�F
GAR. FIREWALL
LATHING 4 ';),G/
MESH
INSULATIONISOUND 2.� -_
FINISH GRADING
FINAL INSPECTION
CERT. OCC
FENCE FINAL
INSPECTOR'S S10NATURESIIN17IALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
nOTICE: THIs C.On _SCHOOL FACILITY FEES to- J,
I k.�A
` CANNOT k1741
'BE DUPLIzOATED,
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that �J QkK VAOAX 4P- -
developer of ax -.R- —M4—Z� VA—L'o � PgZA—C, which is
located at -79�- 120"1 0:U .6 ((kl_tl_ /;;1,5k within
this District, has paid school facility fees imposed pu the
authorit genelrated by Government Code SectimM5300 'n the amount of -7V/00
$ Alti � -1A J/L-041i-^)1
cov4ring a total of,36',S(�' it bi- 'sVuare feet of ()() residenti-al or'
( ) industrial/commercial development and that buildi'hg permits for
this footage in this development y ow be issued by your jurisdiction.
4 977 --75V6 �= 365�? 14a)D
-
for 6-ESERT SANDV-lJNIFIEbr`SCHOOL DISTRICT
White - Building Department 0 Yellow - Facilities Planning 0 Pink - Accounting 0 Gold - Developer
-7--1 (10)-37