003111 (RPL)Building
Address
Owner
Mailing
Address 54-+4$5 Avenida Carrauaa
City Zip Tel,
Lat Quinta.. 92253
Contractor
F` fa F POOILS
.Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 003111'
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number 774-274-:015:
Legal Description
Project Description Fool
' 'City
Zip
Tel.
Distancgs:
Front Setback from Center Line
La Quints
9'2253
56p4-507' 0
Side Street Setback from Center Line
Side Setback from. Property Line
State Lic.
City
INSPECTOR
Issued by:
Date S11 AIR ermil
& Class.if. C-53 476807
Lic. # 130,
Sq. Ft.
No.
No. Dw.
Size
Stories-
Units
. Arch., Engr.; _ ... -
Designer
New �?I, Add ❑
Alter ❑
Repair ❑ Demolition ❑
Address
i
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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
a
\A� effect.
rl `SIGNATURE DATE
_
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
�+q
$ i t A 300'
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 alsoAMOUNT
requires the applicant for such permit to file a signed statement that he is -licensed pursuant to .,
PERMIT
-
the provisions o/ 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
.Plan Chk. Dep.-.'
-
44.52
'subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500).
Plan Chk. Bal.
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.
";
R7
Professions Code: The Contractor's License Law does not apply to an owner o/ property who
builds or improves thereon and who does such work .himself or through his own employees,
Mach.
+
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 burden
I.
'Electrical'
+ +
(
of proving that he did not, build or improve /or the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors.to con-
Plumbing+
00
struct the project. (Seca 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or improves thereon, and .who contracts for
S•M•1. -
R�
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under-Sec.B. & P.C. for this reason
Driveway Enc.
.Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
Thereby 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.)
XPolicy No.' Company
q Copy is filed with the city., O 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 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: I!, 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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
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AV
TOTAL S 1, 51 5 S
REMARKS
ZONE:
BY:
Minimum Setback
Distancgs:
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 S11 AIR ermil
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®,
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE [PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PL BIN
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
ooL ,�Tr--�(. �ti� QoA•�
rr ^ �!
r
" 1
DEC 7
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE .FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL