9804 (RR)P.O. BOX 1504 4' NO. 9804
Building 78194 La €� LA Q 78-105 CALLE ESTADO
Address � UINTA, CALIFORNIA 92253
Owner
Mr. and firs. Hoo t
BUILDING: TYPE CONST.
Mailing OCC: GRP.
:•
Address -yams=
A.P. Number
City La Quinta T1p T
92253l.
Legal Description
Contractor Pro ect Description
Cash Construction i p
Address Roof Enclosure
73.341 Darby Rid.
City Zip Tel.:
Bermuda Dun s 92201 345-1-349
State Lic. City
& Classif. 400211 B Lic. # 354 Sq. Ft. 400 No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ 'Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
Ijhereby 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 ,i'eaF DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a 29,160.00
permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance also
requires the applicant for such permit to role a signed statement that -he is licensed pursuant to PERMIT - AMOUNT
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 Plan Chk. Dep.
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 Plan Chk. Bal. 18 . 9' 3
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 2� so
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, Mech. .
provided that' such improvements are not intended or offered for sale. If, however, .the building
00
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.) - .
154
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
slruct 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.I. 3.00
such projects with a contractor(s) licensed pursuant 4o the Contractor's License Law.) -
0 I am exempt under Sec. B. 8 P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARAT-iON
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of\ 1
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. i
Company
6Copy is filed with the city.. O Certified copy is hereby furnished.
TOTAL 5.u) ., U -!
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit Is for one hundred dollars ($100) valuation
or less.), -
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become
subject .to the Workers' Compensation provisions of the Laboi .Code, you must forth. with
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY -
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I car Illy that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing'Address
City, State, Zip
REMARKS
d 6i1.EH 1L ! is C r�lt..y r$.. > {$ i x i
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear.Setback from Rear Prop. Line ;y "
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. ® $
2ND FL SQ. FT.
FOR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SD. 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
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMSf
i
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ®c
IWATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
12 ✓1-V C N
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71251-V
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SQ.FT.GAR ® Vkc
HOUSE SEWER
VENTILATION
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 L
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSf
i
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
Coll
FOUND. REINF.tl
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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 A7 �� r_
FINAL INSP.
N
7 , f � C -0
ROOFING �""
12 ✓1-V C N
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71251-V
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REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING Q Lfw
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION•
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS�
GARDEN WALL FINAL