10723 (RPL)Building 44-790 SEELEY
Address '
Owner
MAX PLOR
Mailing
Address SAME
City Zip
LA QUINTA922.53
Contractor
Addr435S0 PALKILLA CR
City- Zip
` P.AL� DESERT 92260
Jr" _ _
State;L•ic:
•<8 Classif. C53-542660
Arch En r
� , r
'r
1504
7&105CALOLEESTADO r. No. 10723 -
LA QUINTA, CALIFORNIA 92253
Tel.
Tel.: _
340-5474
City
Lic. # 1540
BUILDING: TYPE CONST. D 1 OCC: GRP. y
A.P. Number
Legal Description
Project Description' PQOL A* ND SPA
Sq. Ft. No. No. Dw.
Size - • Stories Units
I.Designerg
New ❑ Add ❑ Alter O Repair O -Demolition O.
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
71100) of Division`3 of the Business, cdVP-irotessi ns'Code;`and my license is in full force
/effec.• � o-- and -
SIGNATURE DATE
OWNER -BUILDER DECLARATION-
Estimated Valuation
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
_
$13,500
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 ofthe 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-
for the alleged exemption. Any Section 7031.5 by 'any for.
-
Plan Chk..Dep.' -
violation of applicant .a permit
' subjects the applicant to a civil penalty of not more than rive hundred. dollars.($500). . ' '
.. -
Platt. Chk. Bal.".$99.45
O 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,. Buisness and
Const.. 153.00
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,
' 2� tip
provided that such improvements.are not intended or offered. for sale. If„however, the building
.'Mach.
'
or improvement is sold within one year of completion, the owner -budder will have the -burden
Electrical 45. ��
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: 27.00.
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.L. .: .. 1.40
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) •
_
Grading
• • ❑ 1 am exempt under Sec. B. & 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
Worker:s Compensation Insurance, or a certified copy thereof. (Sec. 3800, tabor Code.).
gic,,yrN__G. ompany
Copy is filed with the city. ❑ Certified copy is hereby, furnished. - .
t
Q
TOTAL $349.55
CERTIFICATE EXEMPTION FROMik
• .. WORKERS'COMPENSATION
NSATION INSURANCE
REMARKS ; is t i- r..., a a,;ra-r:r�M• rn rx a rt+s °:,L
(This section need not be completed 11 the permit is for one hundred,dollars ($100) valuation
• �'i�wV 3��s L.•L1% l.'j �. aw s -.I. -.3V 4dt+°^'.a. ” 1J''1 i tj .'�
- -
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,- after making this Certificate of4Exemption you, -should become
ZONE: '• BY:
subject to the workers' Compensation provisions of the Labbe 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 heieby 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 i
Lender's Address
INSPECTOR—
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 Permit
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 theabove-.
-
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. FT. ®
SO 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. BONDING
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
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) METER LOOP
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.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
FINAL INSP.
SO.FT.GAR @ V4c
HOUSE SEWER
ROOFINGfly
_
5/72FIRE
3/" //f /00
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 APPIEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
r GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$ =$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFINGfly
_
5/72FIRE
3/" //f /00
REMARKS:
VENTILATION
ZONE ROOFING
FIREPLACEj
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL