04854 (SFD)TW�t 4 4Q"
Building
Address
Owner
-3ar der+: rat:
mailing
City Zip Tel.
91 -1 r
Contractor
na!;`)•-_merit
Address
is Ern,%,
City Izip Tel.
PA, BOX 1504 "AN ADEQUATELY SIZED DEBRIS GOif. .AINER
LA QUINTA CALIFORNIA 92253 > _ ITE DURING
IS FIEQUIRED ON iliE ,I0' S .
ALL PHASES OF CONSTRUCTIONI'
BUILDING: TYPE CONST OCC. GRP.
A.P. Number 7 7141a*;.) 15
State Lic. w- 14325 City
& Classif. Lic: #
Arch., Engr.,
Designer
Address Tel.
City I Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provlsions 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.
SIGNATURE bATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License law for the following
reason: rSec. 7031.6,Business and prolassions Code: Any city at couny wltkah isQubas a
perm i to construct, alter, imprbve. demolish, or repair any 91aMid(O. prior to Ifs fssuance also
rBQufras the applicant for such permit to [do a signed statement that ha is kensed pursuant to
the provisions of that Contractor's License Law, Chapter 9 (commencing with Sectldn 7000) of
Division 3 of the Buslposs and Professions Code, or that he is axempl 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).
C 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 Licansa Law does not apply to an owner of property who
builds or Improves !hereon and who does such work hkmseil or through his own amployaes,
provided that such Improvements are not iniended or offered for safe. If, however, the &Mding
or improvement is said within one year of complaficn, the owner-buiMer will have rho twrdan
of pravfng that he did not bufid or Improve for the purpose al sale.)
I, as owner of the property, am exclusively contraefing 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 buids or improves thanion, and who contracts for
such projects with a contractor's) licensed pufsuanf to the Confiactar'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
(This section need not be completed if the permit is for one hundred dollars (S100) valuation
or less.)
I certify that In the performance of the 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, 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 permlt when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 certify that I have read this application and state that the above informatlon 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 Inopectlon purposes -
Signature of applicant _Date
Melling Address
City, State, Zip
Legal Description
Project Description
r
Sq. Ft.
Size
No. No. Dw.
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 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, GOLDENiIOD - •S5E55OR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO
ELECTRICAL FEES
NO
PLUMBING FEES
IST FL
2ND FL
POR
GAR
CAR P
WALL
_
ESTIMATED CONSTRUCTION
SO FT rp
SO FT C
SO FT or
SO FT (r
SO FT
SO FT (t
I SO FT Ia
VALUATION
t:
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(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
L
LKITCHEN SINK
ABSORPTION SYSTEM BTU
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.0
SO. FT. ro c
BATH TUB
SO FT a c
WATER HEATER
MAX. HEATER OUTPUT, B.T_U.
SO. Ff. RESID g 1+i. c
SEWAGE DISPOSAL
SOFT GAR g 'i c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DEL
TOTAL FEES MICRO FEE
MECH.FEE
PL.CK.PEE
CONST FEE
ELECT FEE
SMI FEE
PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND SOLAR
SETBACK
G UND PLUMBINV7/4
, NDERGROUND
A C UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC T
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND REINF
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.lEOUIP.
REINF STEEL
GAS (FINAL)
TEMP POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP
BOND BEAM
WATER SYSTEM
GRADING
cu yd
y plus • x5
=S
LUMBER GR.
FINAL INSP
FRAMING —
FINAL INSP.
OOFiNG '.''% � �-
/—
�� J
C?
V
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION r, I
CERT. OCC
FENCE FINAL
INSPECTOR'S S1CiNATURESfINiTkgLS
GARDEN WALL FINAL
Desert Sands Unified School District.
CERTIFICATION OF PAY14ENT
HMO CF.- maq no c OF
(IL CASILIT-1 FEES
RM
TO: City of La Quinta
Department of Communi.ty Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that,&
developer of ae'4- 40-7"
located at P-04,ti�'JMAA
this District, has paid,school fafeility fees
authori,ty erat d b 'JOVULUM, t C9 Secti
$ /. 91fl. t0g7
DATE -
afe= whqkh is
--4) ) , within
imposied pursuant to the
11 53080 in the amount pf
kA
L713
CA
C 6'ering a total of 4 Wei - I ) residential or
v -) WK . JMt4quare feet of ( e
( ) industrial/commercial development and that build6g, permits for
this footage in this development may now be issued by your jurisdiction,.
09 Ha'�
00 44U -4f (). BeAllult
qfnPqFDT1AANDS UNIFIED SCHOOL DISTRICT
White - Building Department 0 Yellow - Facilities Planning 0 Pink - Accounting 0 Gold � Developer
0 007