13715 (SFD)4
F:O. BOX 1504
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Mailing
Address �» a�aF} "j�`r r t -. }- '�..
City Zip Tel.
Contractor
Address
ty I Zip j Te I.
State Lic. City
& Classif. 314 C 7 s Lic# i� r
Arch. Engr.,
Designer
Te 714 j 35 9-G
C9 vi C:� arss-Ce% zip 92;505 Lic.t#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am flcensed under provisions of Chapter 9 Icommencing r11th Sec]lon
TyOpj ofivision 3 of She 8usfness and PraTesslpna Code, and my IicenseJai l lull fa4`and
fect.
S]GNATl1RE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contraclor's Llrense Law for the Following
reason: (Sec. 7031.5.6uslness and Profassions Cads: Any city or county which requires a
Permit to construct, alter, imprgve, demolish, or repair any strucfdre. Prop to t7s Issuance also
requires the spprcant for such permit. to file a signed statement that he Is licensed pursuant to
the, provisions of the Contractor's Lkensa Law, Chapter 9 (commencing with Section 70001 of
DW)iion 3 of the Business and Prafe.Fsions Code, or that. he is exempt therelmm, and the basis
(or the alleged exemption, Any vlolallnn of Section 703 f .5 by any applicant for a permd
sutiecfs the appOcanl to a civil penally of nek more than fiva hundred dallars f$500).
❑ I, as owner of the property, or my employees with wages as their sale compensation, will
do the work, and the structure Is not Intended or offered for sale. {Sec. 7044, Buisnass and
Prnresslans Code: The Ccrdraclor's License Lew does not apply to an owner of property who
builds or kWroves thereon aold who days such work himself or through his own ompfoyees.
proWdad 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-8uiider will have lire 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 Prolesslons 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' 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
LAL-opy Is filed with the city, 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
flirts section need not be completed if the permit is for one hundred dofiars 1100) valuation
or less. j
I certify that In the performance of the 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., 11, 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 appitcat[on and state that the above informatlon Is correct.
I agree to comply with all city and county ordinances and state faws relating to building
❑onstructlon, and hereby authortzo representatives of this city to enter the above-
rrtentioned property for inspection purposes.
Signature of applicant Date
Mailing Address_
City, State, Zip
No. 13715
BUILDING: TYPE CONST. fir. OCC. GRP. R3
A.P. Number
Legal Description _ '_?'ract 23935-3
Project Description plzgn 5"
Sq. Ft. No. No. Dw.
Size =•'-"= Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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 Lime
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date P
LI � ynn
Validated by: ` 12
Validation: r—
CONSTRUCTION ESTIMATE
NO. ELECTRICAL
FEES
NO. PLUMBING
FEtS
$
UNITS
1ST FL SQ. FT.®_
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
iMOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT -
DRAINAGE PIPING
SD.
CAR P- FT -
DRINKING FOUNTAIN
WALL SQ. FT.
URINAL
SQ. FT.
WATER PIPING
ESTIMATED CONSTRUCTION VALUATION $
FLOOR DRAIN
NOTE: Not to be used as property tax valuation-
MECHANICAL FEES
IWATERSOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
GARBAGE DISPOSAL
APPLIANCE DRYER
LAUNDRY TRAY
FURNACE UNIT WALL FLOOR SUSPENDED
KITCHEN SINK
AIR HANDLING UNIT CFM
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
POLE, TEMIPERM
LAVATORY
COMPRESSOR HP
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
SQ. FT. ® c
BATH TUB
BOILER B.T.U.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. 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 r
JLECTRICAL
HEATING
& AIR
COND. SOLAR
SETBACK GROUND PLUMBING S UNDERGROUND A.C. UNIT COLL. AREA
SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK
FORMS SEWER ROUGH WIRING DUCTWORK ROCK STORAGE
FOUND. REINF.A GAS (ROUGH) �� METER LOOP HEATING (FINAL) OTHER APP./EQUIP.
REINF_ STEEL GAS (FINAL) �I TEMP. POLE
GROUT WATER HEATER SERVICE FINAL INSP_
BOND BEAM WATER SYSTEM f f GRADING
LUMBER GR. FINAL INSP. G Lr cu. yd.
FRAMING FINAL INSP. $ plus x$ =$
ROOFING f q REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING cfff��I/
FINAL INSPECTION
CERT. OCC.
FENCE FINAL IN3PECTOR'SSIGNATURESIINMALS
GARDEN WALL FINAL