11310 (RER)Building
Address 51 -900 -Obregon
Owner
Albert Senrev;lle
Mailing Box 1a1
Address P.10.
z
Quinta zip
L 92253
Contractor
Owner/Builde
Address
.i
P.O. BOX 1504 No . 11310
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel. 564-5052
ity - lZip I Tel.:
State Lic. I City
& Classif: Lic. #
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
7000) of Division 3 of the Business and Professions Code, and my license is in -full force and
effect.. .
_SIGNATURE 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 the,
a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also a .
requires the applicant for such permit to rile 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 or 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).
I, as owner of the property, or my employees with wages as their sole compensation, will
o 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.)
❑ I, asowner of the property, am exclusively contracting with licensed contractors to com.
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 r 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.)
Pol icy 'N o. Company
❑ Copy is filed with the city. . O 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 (8100) valuation
or less.) ;
I certify that in the performance of lhg,work for.which.this permit. is issued, 1 shall not
employ any Person in any -manner so as-,to�become'subject to the Workers'•Compensalion
Laws of California. +
DateOwriei i '; % r r'.',,e
NOTICE TO APPLICANTa_ ,)after making'this Certificate or 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
Legal Description
Project Description Bay Window
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
1,000
PERMIT
AMOUNT
Plan: Chk: Dep.
Plan Chk. Bal.
16.25
Const.
25.00
Mech.
Electrical
Plumbing.
S.M.I.
• 20
Grading.
Driveway Enc.
Infrastructure
TOTAL
41.45'
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING F9ES
A.C. UNIT
COLL. AREA
SLAB GRADEROUGH
IST FL. SO. FT. ® $
UNITS
HEATING (ROUGH)
2ND FL. SO. FT.
FORMS 17
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN '
MECHANICAL FEES
_$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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 ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEROUGH
PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 17
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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. S�GI
I
FRAMING 70//
FINAL INSP. RJV/
ROOFING
R41--29612'
J/� _�j)2
r �-`C •[/
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING �lqZ L
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL
�=
— TY . O F LA QUINTA
PDQ a iia ® �R A�a,�5 DEPARTMENT
mNNIhyx' Fes, 9 :Z`- , �".L.
1.
ti
ACCEP
SUglk-F TO',NSiAU %To�sN AS PER
OLE ,CODES
DATE _ ..
C -P �q-p,,_ fi- a r-