003468 (RPL)Building
Address
Owner
Address
City
Contractor
P. it
Address
P.O. BOX 1504 No.
003468
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Zip Tel.
@2253
i9Ca S'9'it �iA964a
Zip — - - Tela
92234 328-P2681
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number PGA east
Legal Description
Project Description Pool spa,
State Lic.
City
& Classif. . 27S796
Lic. # &9
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr:,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑"
Address
Tel.
City
Zip
State
Lic. # -
LICENSED CONTRACTOR'S DECLARATION
hereby I of,Chapter
affirm that am licensed under provisions 9 (commencing' with Section
7000) of Division 3 of the Business and Professions Code; aod'my license is in full force and
effect. �° i'r �X : _ _- .._ 7 -
SIGNATURE' - DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
$2() de -0
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
PERMIT-
- AMOUNT
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-
Any Section 7031:5 'any for
Plan Chk. Dep. ..
-
•- $
for the alleged exemption. violation of by applicant a permit
subjects the applicant to a civil penalty of not more than five.hundred dollars ($500). - -
-
Plan Chk. Bal..
MUM 0,1..3,
❑ 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 .
Const.�G
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,
' Mech.
��
provided that' such improvements are not intended or offered for sale. lf,, however, the building
a
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical-
0(of
proving thal.he did,not build or improve for the purpose of sale.) -
a
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing-
e
e
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
3,
- such projects with a contractor(s) licensed pursuant- to the Contractor's License Law.)
Grading
. ❑ I am exempt under Sec.. B. 8 P.C. for this .reason
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
'I hereby affirm that I'have a certificate of consent to self -insure, or a certificate of
II !
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No.Company
d4a" j
O Copy is filed with the city. 0, Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred'dollars ($100) valuation
or less.) .. .. _.. _
1 certify that in the performance of the work for which this permit is issued, I shall not�;13•�
,ter ♦-rE r ati`" -.{i �,, 5"
r1,;,• ? '-� ..,> _. 4.f, I: ; -_ _-
employ any person in any manner so as to become subject to the Workers' Compensation
ex ; wa, i
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption'you should become
-ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith •
Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from.Center Line
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.)
Side Setback_ from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR'
This'is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
'. `
10 2.` QPe.xrmjt
I certify that I have read this application and state'that the above information is correct.
Issued by: -
Date
' I agree to comply with all city and county ordinances and state'laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-.
mentioned property for inspection purposes.
Validated by:
Signature of applicant . Date
Mailing Address.
Validation:
City, State, Zip
HARD COPY
-.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT, ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
I WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c •
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 34c
HOUSE SEWER
FRAMING
FINAL INSP.
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 ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
t✓l !�
n
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUNDs
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
Cl:I Vm J J umA I V mrbi nlI I1ALb.
GARDEN WALL FINAL