05375 (SFD) VoidBuilding .
Address
T4ht
"
P.O. BOX 1504 No.
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
_ v
NOV GEI E� A TEA' ?9IL'DERS, VIM.
Mailing
Address P.O. BOX 2401
City Zip Tel.
ALM D 9226") �f6—`K!
Contractor
JaRt~L'.
Address
City
Zip
Tel.
State Lic.
& Classif.
City
Lic. #
Arch-, Engr.,
Designer
Address
Tel.
City I
I
Zip State
—
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7D00) of Division 3 of the Business and Professions Code, and my license is in full force and
effect
,- TCNA_TIIRE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that t am exempt from the Contractor's License Law for the following
reason: (Sec. 703I.5.Bushnass and Professions Code: Any coy or county which requires a
perm$ to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such parmil to fie a signed sfatament that ha is Aconsed pursuant to
Me pmvrs uns of the Confractor's License Law, Chapter 9 {commencing with Secfiun 7000) of
Division 3 of the Business and Professions Code, or that_
he is exempt therefrom, and the basis
for the atieged exemption. Any violation of Section 7037.5 by any applicant for a permit
subjecls the applicant to a civil penally of not more than five hundred dollars ($500).
Fl 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. BOisness and
Professions Cada.- The Contractor's Lmonse Law does nor 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 snprovements are not intended or offered for safe. if, Imwover, the budding
or improvemrmt Fs sold within one year 01 compfolion, the owner-bufidef WY have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively Contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Prolessions Code: The Contractor's License taw
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
❑ 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: It, after making this Cartmate of Exemption you should become
sulyect to the Workers' Componsation provisions at 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 77A—,g4 — +
Legal Description
Project Description r1n
05375
k
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
t?9..4()?
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
5
Mech.
; 5�
Electrical
/}-
� , r•
Plumbing
-
S.M.I.
Grading
3,t
Driveway Enc.
Infrastructure
1,914.54
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 ? 27, r Permit
Validated by:
Validation:
MaF�� CONS
vt to be u
E: N
F
4NG E'
AGE UNIT
AN UNIT
oEI NO
RPTIaN SYSTEM
nPF16 �
ING S 1rgTEM
�R
H�Tesa CIUTPVT
MIT FEE
CONSTRUCTION ESTIMATE
>~[LICTION
s�
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
$
UNITS
SQ. FT.
YARD SPKLR SYSTLM
_
SQ. FT.
MOBILEHOME SVC.
BAR SINK
SO. FT.
POWER OUTLET
ROOF DRAINS
SO. FT.
DRAINAGE PIPING
FT.
SQ_
DRINKING FOUNTAIN
SD. FT.
URINAL
SQ. FT.
@
WATER PIPING
VALUATION $
E
STRUCTUR
SET
SLAB GRADE
FORMS
FOUNp• REINF.
REINF STEEL
GROUT
BONA BEAM
LUMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK
ARRESTOR
GAR- FIREWALL
MESH
INSULATION60LIN❑
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
PLUMBING
GROUND PLUMBING
ROUGH PLUMB.
SEWER OR SEPTIC TANK
GAS (ROUGH)
GAS (FINAL)
WATER HEATER
WATER SYSTEM
FINAL INSP.
ELECTRICAL
UNDERGROUND
BONDING
ROUGH WIRING
METER LOOP
TEMP.POLE
SERVICE
HEATING & Ain COND.
A.C. UNIT
HEATING (ROUGH)
DUCT WORK
HEATING (FINAL)
FINAL INSP.
GRADING
FINAL INSP. Cu. yd.
$ plus x$
REMARKS:
SOLAR
COLL. AREA
STORAGE TANK
ROCK STORAGE
OTHER APP./EQUIP.