MISC (0009-069)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Cpapter-9 (commencing with Section 7000) of Division 3 of the Business and
tl -
ProfessionaYs Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby aj-irm under penalty of perjury that I am exempt from the Contractor's
Licupe'Law for the following reason:
( ) 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, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business,&_rofessionals
Code).
O I am exept under Section B&P.C. for th�eason
Date 0"Siorfiature of Owner ""''"
WORKER'S COMPENSATION DEC/IL ATION
I hereby affirm under penalty of perjury one of following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carver Policy No.
(Thi section need not be completed if the permit valuation is for $100.00 or less).
I°� I ceprtify that in the performance of the work for which this permit is issued,
shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I sh`atbfo`rthwith comply with those props.
Date: �,,r Applicant —
Warnin : Faure to secure Workers' Compe;,satror� coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. G'
Signature (Owner/Agent)_ `– ' 7 °�, Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT " TRACT
JOB SITE �'•'°t -
ADDRESS t�¢[q� ¢¢��nnY� 6'tp�,7��T��riripwgy.�a7Ya! �?'A �; •fhb i•^y:Yt,
.A,a'-W'•t(/ �E1. DSr+.�.b A dKeL•.1�.cO`iZA
�APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
LVOY VAQU
`.`Q.lBEt
77.535 CALM ClUFIUAH A,
LAQtlipi".f'A CA 92253
USE OF PERMIT
1 ` "U. AXW, U3
kF.3� OCUF T?IMMIT REMOVE AIN0 UPIACE SkIrI40LE ROOF VATH CUM A
FIRP RATING MATEMAI.Li`NLY
VALUATION 400, DO LS
ES't AUTED COST OF CO.EY,'S'Mi1'C1C1ON
4f'stD.00
MtZI4 T FEE S SIMM Y
YGER )OF FEE 101-000-418.000 X50,00
SUI:! -MTA$,. CON9Tt2.UMIfJN ARD PI.AR Cl :}C
$30.00
LESS FRE -PAW Fa- S
X00
I'MAL PEMM-TYKES DIVE NOW
MAO
✓%
RECEIPT
DATE
` r
DATE NALED
INSPECTOR
v
�BY
__
I
INSPECTION RECORD
OPERATION
A
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
S6t Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck
O.K to Wrap ll 6
Combustion Air
xhaust Fans
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final Q 00
BLOCKWALL AP ROYALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
.Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
T =, 4 Q9
*OF
P.O. BOX 1504 CA( , ,
Building 78-105 CALLE ESTADO
Address 53040 Avenida Mrndcaa LA QUINTA, CALIFORNIA 92253
Bucy Sanchez
Mailing
Address 53040 Avenida mF3I;i oza
City I Zip ITel.
Contractor
Address
City lZip
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
70 OO) 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 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
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
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
do 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.) -
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
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 Contractor's License Law.)
❑ 1 aim exempt under'Sec. 1 9, /B. & P.C. foNth s reason
...:Date
f
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.)
Policy No. Company
❑ Copy is filed with the city. ❑ 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 ($100) valuation
or less.)•
I certify that in the performance of thg 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 of 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 it 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
{1�9
BUILDING: TYPE CONST:
Number
I Description
No. 11534
-OCC: GRP.
-
Project Description
REMARKS
' f..nr•.c tt^+ t •'!r<r+n.. 4.r1.: 1,'1...C1'^, c{t
V utyfmt.: X O v.VU
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:
Validati
0
Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ 'Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk: Dep.
Plan Chk. Bal.
Const.
30.00
Mech.'
Electrical
Plumbing
S.M.I..
Grading
Driveway Enc.
Infrastructure
TOTAL
30.00
REMARKS
' f..nr•.c tt^+ t •'!r<r+n.. 4.r1.: 1,'1...C1'^, c{t
V utyfmt.: X O v.VU
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:
Validati
0
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. Sp, FT, ®
CAR P. SQ. FT.
WALL SQ. FT. ®
Sp 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
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% c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
REMARKS:
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 QFfB6piIG.T6CUL;/
OUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION!(1,2-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Received F
Address:
Account N
Service Ad
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge
Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment A.D. - Bond
COACHELLA VALLEY WATER DISTRICT
so - dilf Tt%
❑ Customer Deposit
❑ Other
TOTAL $ I 12 2
Remarks:
5
Address
Type of Business RESTAURANT
CALLE ESTADO
2880Name
X
m
Y
EDIstrict78039
EL RANCHITO RESTAURANT
NO
R 2 VER S I DE COUNTY
F = RE DEPARTMENT
Date 1 1 - 9 2 By COX
Conditions and Hazards
Emergency Phone Contact
564-7047 DAVE CETINA 564-2517 ARMANDO ARZAPAL
Business Phone 564-0061'
64-0061
Type of Business RESTAURANT
Fire Control System HOOD AND DUCT SYSTEM
X
m
Y
CONSTRUCTION INFORMATION
Occupant Load
49
Ht. 12
JFjFTLth.
60.
jWth.25
HYDRANTS
v
J
0
Roof .WOOD BEAM/TILE
150 ft' 2000 gpm
2 300 ft. 2000 gpm
3 ft.
Exterior Wall
4 ft.
Floor
NA
6 ft.
L
Area -and Water Supply -
N
0,11'.LL T10,IPI CO -
R 2 VER S I DE COUNTY
F = RE DEPARTMENT
Date 1 1 - 9 2 By COX
Conditions and Hazards
Emergency Phone Contact
564-7047 DAVE CETINA 564-2517 ARMANDO ARZAPAL
Business Phone 564-0061'
64-0061
E
A
S
V
L
ll
AVD. LA FONDA
It
13
T
L
C
�� IZ
CALLL LSTADO
L
lU
ON
U
B
D
A
D
;S
R
m
as
m
V
R 2 VER S I DE COUNTY
F = RE DEPARTMENT
Date 1 1 - 9 2 By COX
Conditions and Hazards
Emergency Phone Contact
564-7047 DAVE CETINA 564-2517 ARMANDO ARZAPAL
Business Phone 564-0061'
64-0061
• a P.O. BOX 1504 No. 9188
Buildrin "78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
53�-�1�� t�lzxac�z� - -
Owner L1y
Z nyr 1T� ��v. BUILDING: TYPE CONST: OCC: GRP.
Mailing, . ; ,.
Address —
A.P. Number
City Zip Tel:
4 Legal Description
Contractor Project Description t?sis� 3 ar
-Address -
State Lic.
& Classif.
Arch:; Engr.,
Designer
Address
Zip Tel.:
city
Lic. # Sq. Ft.
Size
New ❑
el.
No.No. Dw.
2 Stories,• • -Units
Add ❑ Alter ❑ _ Repair ❑
CityZip
REMARKS
State
• WORKERS' COMPENSATION INSURANCE
Lic. #
-
LICENSED CONTRACTOR'S DECLARATION .
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 130) of Division 3 of the Business and Professions Code, and my license is in full force and '
- effect. - - - -- - '
I certify that in the performance of thg work for which this permit is issued, I shall not
'employ
- • 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 requires a
'rJ 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
'•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
• 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
do 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
•
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal'.
Const.,
Mech,
builds or improves thereonand who does such work himself or through his own employees,,:
'i;':'j"provided that' such improvements are notintended or offered for sale. If, however, the building
-.or improvement is sold within, one year of completion, the owner -builder will have the burden
ofproving that he did not build or improve for the purpose_of sale.)
o
Electrical
Plumbing
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
' 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 Contractor's License Law.)
0 I am exempt under Sec. B. & P.C. for this reason
-S,M.I,
Grading
Driveway Enc.
•
Date owner. �'�` - '�`s2
Infrastructure
° WORKERS' COMP NSATION.DECLARATION k{
Y`
hereby affirm that there is a construction lending agericy.for,the performance'oi the
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
work for which this permit is issued. (Sec: 3097, Civil Code.) ,• - `
Worker's Compensation Insurance, Ora certified copy. thereof. (Sec. 3800, Labor Code.)
-
Policy No. Company
_
O Copy is filed with the city. O Certified copy is hereby furnished.
Lender's Address
TOTAL -
INSPECTOR
Demolition ❑
CERTIFICATE OF EXEMPTION FROM
REMARKS
• WORKERS' COMPENSATION INSURANCE
(This section need not be • completed if the permit is for one hundred dollars (S 100) valuation
-
or less.) ..
I certify that in the performance of thg work for which this permit is issued, I shall not
'employ
,res+
Gir+s��sT y. {rad}f_A j°
any person in any manner so as to become subject to the Workers' Compensation
Laws of California.-
DateOwner ` ..
NOTICE TO APPLICANT: 'll after -making"2thts/Csilif6ate of Exemphon�you1 ", hould become
.ZONE:•
`'BY: '
subject to the Workers' Compensation prows ons of the Labor cbo a ,X ouj must ;forthwith
comply with such provisions or this permit shall be deemed revoked. f l` , -
- -
Minimum Setback Distances:.. '•. _
,
"
Front Setback from Center. Line
-
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY'
Side Street Setback from Center. Line
hereby affirm that there is a construction lending agericy.for,the performance'oi 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 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 the above•.
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
f
��
:.Y'�t 4 C'i. •f�l`..t tr�L rte' `F� R} Y -2 r�.4.�`.i lY,f `r � .Y ::n � �r �.5
`�,2'� Y • •�� -%t'
{-,T• t - 'r•. ; �'L i- t r '1
4"tiy-.��t� a.
L
.L'L {.' J r'1 I r`:, �-4.+. ,T -1 p,: � ... .R� i i
Y ; �S
�•� .Y' ) H^! •3.�A, tr ) [1" i -jr �J, t
�
.Y; fr; IE15• r 6 'i`�:. �: >�•;�-� .T ..... E.r_•.••a''� -,+` /•'£ a.gs•; i.. - ..
t�:
f _is .t�-aX.it"Y
is .\ "ti -3. �. �,..r
:?d ,...i,'_'�j' f ,, �'. ...`'v3'??,��,: r4.v r�'-,yy,, ,:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. S0. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CAR P. I 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
S0. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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 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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
' • T41i
�.1 ��I'/1Y� r 1 1• D r r
'P.O. BOX 1504~- No918
Building!78-105 CALLE ESTADO• r,
Address 53~040. MendozaLA QUINTA, CALIFORNIA 92253
Owner �L ! : • ,
Lucy R` Vaz ez Sanchez
BUILDING., TYPE CONST.- J OCC: GRP:
Mailing - ,
Address sate A.P: Number
City. Zip Tel.
Lal Qe iniz 92,253 569-3636 Legal Description F. '
Contractor Project Description psa.9.4 c►
Address j _ • ,
City Zip Tel
State'Lic. City
& Classif. Lic. # Sq. Ft., No No. Dw.
Size 324 Stories_ Units
Arch:, Engr., ••
Designer New ❑ Add ❑- • ',`Alter ❑ . Repair ❑ Demolition ❑
Address Tel.
City Zip State ay
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 _ • 1
OWNER -BUILDER DECLARATION
Estimated Valuation ^
I hereby affirm that I am exempt from the Contractor's License Law for the following '* A
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
r;•�requires.the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT I AMOUNT
•.-the,provisfons o/ the'Contractor's•Ucense Law, Chapter 9•(commencing with Section 7000) of
e —vision 3`ol .the Business and Professions Code, or that. heisexempt therefrom,, and the basis - k
�•!or^the• alleged exemption. -Any violation of Section 7031.5-by'any applicant /or a permit Plan Chk. Dep. r•
•.' subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 1;66 owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work; and.the structure is not intended or offered for sale. ,(Sec. 7044, Buisness and
.s:.' Const.
Professions; The Contractor's License Law does not apply to an owner of property who
"builds., or improves : thereon andwhodoes such work himself or through his own employees,•> ,
-. provided. that such, improvements are not intended or offered for. sale.. If, however, the building Mech.
or improvement is sold within one year of completion, the owner -builder will, have the burden -Electrical
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, BusinessaridProfessions Code: The Contractor's License Law -
• does not apply to an owner o/ property who builds or improves thereon, and who contracts for S. M. 1.
'such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C..for this reason Grading r
- Driveway Enc.
Date Owner .ra Infrastructure ,
�-f l� v •r s x -
1.
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.)'•'.J
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL K ;
CERTIFICATE OF EXEMPTION FROM REMARKS.
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for.one hundred dollars ($100) valuation h
or less.) - - - -
certify that in the performance of thg work for whichthis permit is issued, I shall not
employ any person in any manner so as. to become subject to the, Workers' Compensation'
Laws of California. d-rj' : +
Date Owner cc ? • ;ri
NOTICE TO APPLICANT: 1! 'a/tei+!'making lhls,, CBrtilic'ate of«Exerripban- youpshould become ZONE:• - BY: - - -
subject to the Workers' lComp`ensahon provisions o/ the Labor Code, you. 9nust forthwith'
comply with such provisions 67this permit shalhfie 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,.Civn 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 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 the above•.
mentioned property for inspection purposes. _ Validated by:
Signature of applicant Date
Mailing AddressValldatlon:
City, State, Zip"
�
•t.�~' �.s-.-F .�s. j s �_'�Y'�' � - �� nSiFr',sf • � � tfi c �Ft: F �� .� if� 1. �: } is rt ti. tt. �.
r . Y ;•. -'''+l _ ''•� •ct X' . ' �.r.' f ' d� •2 , • �`C+�:1"' ; `�:, < , ,.�:v:.t r}^- r '� ,!� c r �;" _�'�, <,,s '`_
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ, FT, ®
GAR. SO. FT. ®
CAR P. 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
WAIER PIPING
NOTE: Not to be used as property tax valuation
f/ A�
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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 ® 1+/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
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 6
(/ Aw
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE6
f/ A�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL