10546 (RER) IIIIIII VIII III VIII IIII 75
/ IE _�J
P.O. BOX 1504 No. 10546
Building 78-105 CALLE ESTADO
Address 49-398 Avila LA QUINTA,CALIFORNIA 92253
Owner
Kenneth A. Nelson BUILDING: TYPE CONST.
Mailing OCC:GRP.
Address Box 300
A.P. Number
City Zip Tel.
La Quinta 52253 564-4400 Legal Description
Contractor Project Description Remo d& of existing SFr7
Gvner/Buil,der add 364 ,f of living space
Address..... g
City Zip Tel.:
State Lic. City
&Classif. Lic.# Sq. Ft. 364 No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ 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
I hereby affirm that I am exempt from the Contractor's License Law for the following 1846
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a r _
permit to
thconstruct, alter, Improve, demolish, or repair any structure, prior to Its Issuance also AMOUNT
requires e applicant for such permit to file a signed•statement that he Is licensed pursuant to -• PERMIT `� - '
the provisions of the Contractor's License Lew, 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 Plan Chk. Dep." '
subjects the applicant to a civil penalty of not more then five hundred dollars($500). -
ip 1,as owner of the property,or my employees with wages as their sole compensation,will Plan Chk. Bal. 328. 70
do the work,and the structure is not intended or offered for sale.(Sec. 7044,Bulsness and Const. �'_' 198.00
Professions.Code: The Contractor's License Lew 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. - ' '• 15 00
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 Electrical- 5.00
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 25.00
,struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law n
-does not apply to an owner of property-who builds or Improves thereon, and who contracts for S.M,I. .�u
such projects with a contractors)licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B.&P.C.for this reason
,r Driveway Enc.
Date Owri�ll -^1� ',.-.,4'��f.�`.�*".-^*a-"-•.+'
Infrastructure
xb`i+-ti
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self-Insure, or a certificate of -
Worker's Compensation Insurance,ore certified-copy thereof.(Sec.3800,Labor Code,)
Policy No. Company
)} i �t >
❑Copy is filed with the city. ❑Certified copy Is hereby furnished. �_'�± " �'°; 1
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE
(This section need not be completed if the permit Isfor one hundred dollars ($100) valuation
or less.)
I certify that In the performance of thip 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. fiE•" f
Date Owner,r� '`t as` •t •, .» '.
NOTICE TO APPLICANT: 11 after making this Certificate of Exemption you should become ZONE: BY:
subject 7o the Workers;[dompensatlon 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.
I certify that I have read this application and state that the above Information 1s 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 the above-.
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,
IST FL. SQ.FT.® $ UNITS
YARD SPKLR SYSTEM
2ND FL. SQ.FT.
POR. SQ.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. I SO.FT.® DRAINAGE PIPING
WALL SQ.FT.
DRINKING FOUNTAIN.
SO FT ® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation 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 LAUNDRYTRAY
AIR HANDLING UNIT CFM 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
SQ.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SQ.FT.RESID®1+/4 c SEWAGE DISPOSAL
SO.FT.GAR®3/ic 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 1p 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)2
AS(ROUGH) METER LOOP HEATING(FINAL) OTHER APP.IEQUIP.
REINF.STEEL GAS(FINAL) ` TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP.
cu.yd.
FRAMING3. �v FINAL INSP. ? �G $-Plus-X$-=$
ROOFING ^ ^ � Q�/� ,�/J REMARKS:
VENTILATION
FIRE ZONE ROOFING: C`G
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
NG
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTIO
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL