04780 (PLBG)�.
4
P.O. BOX 1504
Building 40..495 Gui Jarro 78-105 CALLE ESTADO
Atiriracc LA QUINTA, CALIFORNIA 92253
Owner Maple I
Address Sam
City Zip Tel. _
La 'Winta 92253
Contractor
ress
city?alm Des®rt I Zip 92260 Tel.,,6-37,93
State Lic. City —
& Classif. 490961 Lic. # 342
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
Lic. #
1—LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed undei provisions of Chapter 9 (commencing with Section
7000) of Division 3 of,the Bus ness and "Professions Code, and my license is in full force and
effect. 1�/ 11 k V�A e
SGNATURE ' % 7 DATE
,,.OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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).
❑ 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.)
0 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 Compensation Insurance, or a certified copy'thereof. (Sec. 3800, Labor Code.)
Policy No. - 't t. Z�+ company • —'"L.
1.1i❑ Copy is filed with the city. O Certified copy, is herby furnished.
t�
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., Il, alter 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 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
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number w Gq).f Estates
Legal Description
Project Description — S' wor Roo -k -up
0A 710
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
wmatea valuation $300
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. ;fLV «1i t3
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc. .
Infrastructure
TOTAL
REMARKS n 7 x,, -.,.. r ; A n >_ iir 1
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: Datell/7J33 Permit
Validated by:
Validation:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
T4t,t 4 4 "
P.O. BOX 1504
Building 78-105 CALLE ESTADO�
Address LA QUINTA, CALIFORNIA 92253
Owner 0
Mailing
Address _;;;;.;,.
City I Zip ITel.
Contractor
Y-: i li(.
Address
City `Zip
State Lic. Icity
& Classif. Lic. # 342
Arch., Engr.,
Designer
Address Tel,
City Zip State
Lic. #
,LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70ool of Division 3 of the Business and Professions Code, and my license is in full force and
effect. ___.
sio NATURE_ _ 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 requiem 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 permif
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, Bussness 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.)
O 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 contraclor(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 lei 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. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This sacteon need not be complarad if the permrr is for one hundred "ars ($100) valuation
or less. )
I certify that in the performance of Shp work for which this permit Is issued, I Shall not
employ any parson In any manner so as to become subject to the Workers' Compensation
Laws of California.
Date -Owner
NOTICE TO APPLICANT. if, after making this CaritiCale or Exemption you should become
subject to the Workers' Compensation provisions of the Labor Cade. you must forthwith
comply with such provisions or (his Pemdl shad be deemed rewired.
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 app€Icatlon and slate that the above informatlon Is correcl.
I agree to comply with all clly 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
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description
OCC. GRP.
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. {}ep.
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. L ine
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 W
2ND FL
SO FT 0
POR
SO FT er
GAR
SO FT
CAR P.
SO FT 0
WALL
SO FT ttt
SO FT g
ESTIMATED CONSTRUCTION VALUATION
NOTE Not to be used as property tax value
MECHANIC
VENT SYSTEM FAN
EVAP.COOI
APPLIANCE
FURNACE UNIT WALL FLOOR
AIR HANDLING UNIT
ABSORPTION SYSTEM
COMPRESSOR
HP
HEATING SYSTEM
FORCED
BOILER
B.T.U.
MAX HEATER OUTPUT, B T.0
PERMIT FEE
DBL TOTAL FEES
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC
FENCE FINAL
ESTIMATE
s
NO
ELECTRICAL FEES
UNITS
MOBILEHOME SVC
POWER OUTLET
NO
I
PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
s
WATER PIPING
ion
FLOOR DRAIN
,L FEES
WATER SOFTENER
HOOD
SIGN
WASH ER(AUTONDISH)
DRYER
GARBAGE DISPOSAL
SUSPENDED
LAUNDRY TRAY
KITCHEN SINK
CFM
BTU
TEMP USE 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 1'A c
SEWAGE DISPOSAL
SO FT.GAR Y c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
MICRO FEE MECH.FEE
PL.CK.FEE CONST FEE
ELECT. FEE
SMI FEE
PLUMB
FEE
PLUMBING
ELECTRICAL
GROUND PLUMBING
UNDERGROUND
ROUGH PLUMB
BONDING
EWER OF, SE
ROUGH WIRING
GAS (ROUGH)
METER LOOP
GAS (FINAL)
TEMP POLE
WATER HEATER
SERVICE
WATER SYSTEM
FINAL INSP
StGNA
FINAL INSP
HEATING 8 AIR COND SOLAR
A C UNIT
COLL, AREA
HEATING (ROUGH)
STORAGE TANK
DUCT WORK
ROCK STORAGE
HEATING (FINAL)
OTHER APP.IEOUIP
FINAL INSP
GRADING
cu. yd
y plus xS =S
REMARKS:
GARDEN WALL FINAL