11664 (RPL)11664
Building P.O. BOX 1504 { \� No.
_ 78-105 CALLE ESTADO
AddresS V
Address LA QUINTA, CALIFORNIA 92253 C!P
Owner
Bob A�.cal.a
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address - aMp
A.P. Number
Cityip Tel.
La Quanta, CAT
92253 Legal Description
ContractorProject Description
P001. 3' &" setback, anrIrny,,-f5
Owner/Bu3..Ider
Address __. by planning.
ity
State Lic.
& Classif.
Arch., Engr.,
Designer
Zip j Tel.:
City
Lic. #
Sq. Ft. No.
Size Stories -
New ❑ Add ❑ Alter ❑
No. Dw
Units
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
70 130) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
-9GNATl1RE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License taw for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, 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] 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.)
&< 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•1 am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
8 {� rj • 00
PERMIT
AMOUNT
. .Plan Chk. De oti
Plan Chk. Bal.
Const.
y
Mech.
Z4 • UU
Electrical
45 e U U
Plumbing
x
S.M.I.
• 8 U
•Grading
Driveway Enc.
Data/-'-2—Owner .`ti.t,tr�-�-`�
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, Labor Code.)
Policy No.Comp'any
❑ Copy is filed with the city. f Certified copy is hereby furnished.
-
TOTAL
zoD • [.2
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
employany parson 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
Ihereby 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
ateMailing Address
City, State, zip
REMARKS
q-1 t t: .':'< $ # : _. A—.0 r r)
Lit"ut'arl 1•.ItSfh1, t f.L•L..1.!
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 FEES,
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. - SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT. ®
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING
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,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
MESH
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
47UNDERGROUND)
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
FINAL INS ��
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
FINAL INSP. 3
ROOFING
. (-, /,2/
CIA C
1 '�✓ J q/
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
NSPECTION
FINAL INSPECTION-
CERT.
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL
:d
�LE ESTADO — LA QUINTA, CALIFORNIA 92253 (619) 564-2246
CASE NO:
CITY OF LA QUINTA FE .::
$100.00
TING & DEVELOPMENT DEPARTMENT
:CATION FOR SETBACK ADJUSTMENT
form with two copies of a scaled site plan,
(.i,00 ct the nature of the request. A nonrefundable
.,�;,.�;•,..;;; ,; ;; hen the Application is submitted. Check must be
J'0Tr;l... ;.f) of La Quinta" .
the owner of the property, a letter must be
ithorizing the Applicant to execute this document
PLEASE PRINT OR TYPE
APPLICANT/CONTRACTOR: /�Oa.% L c A L A
DATE �.Z�/
2—
CONTACT PERSON (I F DIFFERENT)
PHONE 3 67
MAILING ADDRESS:
5/-'4-7Z) ,Ao:
Ou,00TA
CA
'122,5 3
(Address)
(City)
(State)
(Zip)
OWNER'S NAME:
'sp0-t
PHONE
MAILING ADDRESS:
SA "O
(Address)
(City)
(State)
(Zip)
STREET ADDRESS OF
PROPERTY: .SAr�-tom'
LEGAL DESCRIPTION
OF PROPERTY: LOT #
TRACT
7
ASSESSOR'S PARCEL NUMBER: "`:.t:: .i "'Ci.=; i•T-' 1
ADJUSTMENT REQUESTED: "1
REASON FOR REQUEST: 4fr To Co •-572U c j �oo c_ 1 -o -F/ -' /,) c(412-1)
JUSTIFICATION: No request for a Setback Adjustment shall be granted
unless it is determined that it is consistent with the intend and purpose
of this Ordinance; that there are special circumstances applicable to the
property, including such factors as size, shape, topography, location or
surroundings that justify the approval of the adjustment of the setback
requirement, and that the adjustment will not be detrimental to the
health, safety, and general welfare of the community or be detrimental to
property in the area of the parcel for which the adjustment is requested.
FORM.013/CS
Z
:t.4
c� oma.
Dear Property Owner:
An application for a building permit has been submitted in your
name listing yourself as the builder of the property improvements
specified.
For your protection you should be aware that as owner -builder you
are the responsible party of record on such a permit. Building
permits are not required to be signed by property owners unless
they are personally performing their own work. If your work is
being performed by someone other than yourself, you may protect
yourself from possible liability if that person applies for the
proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the
State of California and to have a business license from the city
or county. They are also required by law to put their license
number on all permits for which they apply.'
If you plan to do your own work, with the exception of various
trades that you plan to subcontract, you should be aware of the
following information for your benefit and protection:
If you employ or otherwise engage any persons other than your
immediate family, and the work (including materials and other
costs) is $200 or more for the entire project, and such persons
are not licensed as contractors or subcontractors, then you may be
an employer.
If you are an employer, you must register wilth the state and
federal government as an employer and you are subject to several
obligations including state and federal income tax withholding,
federal social security taxes, workers' compensation insurance,
disability insurance costs, and unemployment compensation
contributions.
There may be financial risks for you if you do not carry out these
obligations, and these risks are especially serious with respect
to workers' compensation insurance.
...
16
For more specific information about your obligations under federal
law, contact the Internal Revenue Service (and, if you wish, the
U. S. Small Business Administration). For more specific
information about your obligations under state law, contact the
Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale, property owners who are not
licensed contractors are allowed to perform their work personally
or through their own employees, without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be
contractors is to secure an owner -builder building permit,
erroneously implying that the property owner is providing his or
her own. labor and material personally. Building permits are not
required to be signed by property owners unless they are
performing their own work personally.
Information about licensed contractors may, be obtained by
contacting the Contractors State License Board in your community
or at 3132 Bradshaw Road, Sacramento, California, Mailing Address:
P. O. Box 26000, Sacramento, California 95826.
Please complete and return the enclosed owner -builder verification
form so that we can confirm that you are aware of these matters.
The building permit will not be issued until the verification is
returned. o
Very truly yours.
CITY OF LA QUINTA
BUILDING AND SAFETY DEPARTMENT
IM
V
•c
Z ro
of n+�
OWNER -BUILDER VERIFICATION
Attention -Property Owner:
An owner -builder permit has been applied for in your name and
bearing your signature.
Please complete and return this information at your earliest
opportunity to avoid unnecessary delay in processing and issuing
your building permit. No building permit will be issued until
this verification is received.
1. I personally plan to provide the major labor anSkmaterials for
construction of the proposed property improvement yes' r no)
2. I av*haVe not). k w—e_ signed an application for a
building for the proposed work.
3. I.have contracted with the following person (firm) to provide
the proposed construction:
Name 1
Address City
Phone Contractors License No.
4. I plan to provide portions of the work, but I have hired the
following person to coordinate, supervise and provide the major
work:
Name V) A
Address City
Phone Contractors License No.
5. I will provide some of the work but I have contracted (hired)
the following persons to provide the work.indicated: (see attached)
RPT1
OWNER -BUILDER SIGNATURE
TAT 4
P.O. Sox IN4
7b 105 CALLE ESTADO
LA OUINTA. CALIFORNIA 92253
Contractor Owner cu no S- C
Address Job Address 5 — Ln 0 C,4 e_to.,1 2,4
La Quinta City License No.: Expires: Bldg. Permit No.:
L2.
L3.
L4.
L5.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Plastering {
HVAC
This, form shall be posted on the job with the Building Inspection Card and it
Electrical 'br's
shall be the duty of
the General Contractor or if Owner -Builder Permit, the owner
NPVY-
to see that all sub -contractors sign this card, giving his City of La Quinta
�Dvjyw
Business License Number, Contractors License Number and a current certificate
Of Workman's Compensation Insurance Certificate when he starts the job. Failure
o U"^4�.
to comply may cause
Building Inspectors to stop work, or complaints to be filed
SGwW ('M 4 _
against such contractors or owners.
bt"111—
Til e
CITY CONT.
SUB -CONTRACTORS
NAME LIC. NO. EXPIRES LIC. NO. EXPIRE:
I.
Grade i Excavate
Fences/Blockwalls
2.
Pipelines
11
3.
Cement -Foundations
(�Lp1Y%^Vl
4.
Cement Walks i Drives
��%V)
5.
Asphalt Paving
U4y-k
6.
Framing
7.
Steel Structural
ll
8.
Masonry
h Q
9.
Plumbing
�1���✓
L0.'
Lathing
D Ur►"`r
L1.
Drywall
L2.
L3.
L4.
L5.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Plastering {
HVAC
A 61 W ewyK ar-
Electrical 'br's
r I2C gd-_
Roofing
NPVY-
Sheet Metal
�Dvjyw
Floors -All Types
Glass - Glazing
o U"^4�.
Insulation/WeatherstriOG-L �yiY,il��i1r�15
Sewage Disposal
SGwW ('M 4 _
Painting/Decorating
bt"111—
Til e
( 1,
Cabinets -Installations
w �►IY�Vy/�
w
Ornamental Metal
VAA,
Fences/Blockwalls
•VA -v -
Landscaping
Others
f DO NOT REMOVE THIS CARD
Before Final Building Inspection Will Be Made
This Form Must Be Completed and Filed With Title 24 Calcs and Plans
Tilf 4 4 QuW0
P.O. sox 1504
78,105 CALLE ESTADO
LA OUINTA. CALIFORNIA 92257
Contractor Owner 0)z b C�
Address Job Address e.G',tyU\-2A,
La
Quinta City License No.: Expires: Bldg.
Permit No.:
This form shall be posted on the job with the Building Inspection Card and it
shall be the duty of the General Contractor or if Owner -Builder
Permit, the owner
to see that all sub -contractors sign this card, giving his City
of La Quinta
Business License Number, Contractors License Number and a current
certificate
of Workman's Compensation Insurance Certificate when he starts
the job. Failure
to comply may cause Building Inspectors to stop work, or complaints
to be filed
against such contractors or owners.
CITY
CONT.
SUB -CONTRACTORS NAME LIC. NO. EXPIRES
LIC. NO.
EXPIRE:
1 .
Grade & Excavate
2.
Pipelines
3.
n
Cement -Foundations CrR U1l In 2161
4.
Cement Walks i Drives
5.
6.
7.
8.
9.
10.'
L1.
12.
L3.
14.
15.
L6.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Asphalt Paving
Framing ✓
Steel Structural
Masonry
Plumbing ?4Dk Adl. 71aM%�
Lathing
l
Drywall
Plastering Lr, Mt(
HVAC
6 d� t't
X16 o,654( /,? e,-3
Electrical 12oa5,&_ Q(e bo 510 m
Roofing
Sheet Metal f�
Floors -All Types
Glass - Glazing
Insulation/Weatherstrip
Sewage Disposal -�
Painting/Decorating
Tilef�c1Z �`�j"1R�- 1��3
Cabinets -Installations -�`-
Ornamental Metal ✓
Fences/Blockwalls
Landscaping f
Others
�41 % �� �� _� 3(0 l �Z t ;ZK iso/ y tl
DO NOT REMOVE THIS CARD
Before Final Building Inspection Will Be Made
Thi C C .� �.�. M . � c t O o /' n...... 1 � � o A � n r1 C : 1 0 .i •.? i � L, rn : � 1 � "1 , r. � 1 ,... _ _..? ^ 1 .. ..