003102 (AR)44
3�GaG�Gu '
P.O. BOX 1504 No.
�'�
Building 78-105 CALLE ESTADO
02
Address•• LA QUINTA, CALIFORNIA 92253
Owner
Rev Re's BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 52-401 Obregon A.P.'Number 773-254-025-.
City Zip Tel.
La .iDu 922553 -• 56th -4666 _ Legal Description
Contractor Project Description Room additi n .
tYrs3�a�-/Raxi ldem
Address .. .
City. _ Zip Tel.
State Lic. City
& Classif. Lic. # Sq. Ft. 380 Pati-BNo. No. Dw.
Size t, --Stories.. Units
Arch:,-Engr.,
Designer New ❑ Add ISP Alter ❑. Repair ❑ : Demolition ❑
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 Estimated Valuation
.l hereby affirm that I am exempt from the Contractor's License Law for the'following .. -$23,,467
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, C_ hapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is- eiiempt therefrom,and the basis _
-for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit, Plan-Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). - '
❑ 1, as owner of the. property, or my_employees with wages as their sole compensation, will Plan Chk. Bal. S104-92
do the work, and the structure is not intended or offered for sale. (Sec. 7044; Buisness and ' Const. p
Professions Code: The Contractor's License Law does not apply to an owner of property who T �4 _50
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. If, however, the building _ 1 -1 — 0
or improvement is sold within one year of completion, -the owner -builder will have the burden Electrical '� _ pry
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- Plumbing
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 S•M•1. ^f _
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec. B. 8 P.C. for this reason Grading
Driveway Eno.
Date' Owner Infrastructure
i14J"t 3`? alt ±t7.A. �•t"a!,^'iSf_._ a'.
WORKERS' COMPENSATION DECLARATION 'Y �J rf1 if t .t : s7 f €4i_ it.
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.. O 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.)
I certify that in the performance of thg work for which thispermitis issued, I shall not '
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owrier
. NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions`of the -Labor Code, you'must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: " -
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,Llne
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 if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
Issued by:
Date ; tz /R7 Permit
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. I SQ. FT.
WALL SQ. 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
ROUGHROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
UMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
p
1. F MING 7 ��
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
ROUGHROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
RMS �7 �4 s
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$
_$
UMBER GR.
FINAL INSP.
p
1. F MING 7 ��
FINAL INSP.
ROOFING
DEC 17
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
HING97, c
MESH
ULATIONISOUND� `,
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
- c , f(�d► .
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify t at
developer owhich is
located at f p`1 within'
this District, has paid s hool facility fees imposed pursuant to the
authority genera b Governm t Code SectioSt3080�j'•n the amount of
covering a total of Q square feet/of (ky—) residential or
( ) industrial/commercial development and that building permits for --
this footage in this development may now be issued by your jurisdiction.
Y
f DESERT SA DS NIFIED §CHOOL DISTRICT
White -'Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
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