003888 (BLCK)(` • f.
414 a
P.O. BOX 1504 No. 003888
Building 52-315 RUbio 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Bill r*yle
Mailing
Address 52-355 Rubio
City ZipTel.
. .Quinta 92253
Contractor
K6n ' Fdars' n -nth M'tescxy .5ygt
Address. .
P. 0a 90X 149 ,-
City Zip , : Tel.'
La Quinta 92253 ti 6 92,fl
State Lic. City
& Classif. 436878 Lic. # 356
Designer
BUILDING: TYPE CONST:' OCC: GRP.
A.P. Number 773-252--015
Legal Description
Project Description 190E of st9ucc® 'wall
Sq:. Ft.
Size -
No. No. Dw.
Stories Units
New ❑ Add .0 Alter ❑ Repair ❑ Demolition ❑
Address 'Tel.
City Zip State
Lic. #
LICENSED CONTRAgTOR'S DECLARATION
I hereby affirm that I am,licensed,under provisions of Chapter 9 (commencing with Section
7000) of Division 3,of'therBusiness and`Professions Code, and my license is in full forceland • '
effect.
SIGNATURE ��" - - .r "DATE '
'� OWNER BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
��
Minimum Setback Distances:
reason: (Sec. 7031.5,Business and Professions Code: Any city or. county which requires a
,F
permit'to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for. such'permif to Rte a signed. statement fhat'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 Codeor that he is. exempt* therefrom; and the basis
for Any Section 7031.5 by 'any for
Plan Chk.' Dep.
:Issued b Y:.
the alleged exemption. violation of applicant a permit
subjects the applicant to a civil penalty of not more than'live'hundred dollars ($500).
Plan Chk. Bal.
"
❑ I, as.owner of the property, or my employees with wages -as their sole compensation, will
Validation:
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
�'
AIn 9.8
Professions Code: The Contractor's. License Law does not apply fo'an owner ol• property who
-
buildsor improves thereon and who does such work. himself or through his own employees,
' Mech.
., provided fhat'such improvements'are not intended or offered for sale. If, however, the building
or improvement is sold within one year of complefion,• 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, 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.Md.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
-
Grading
'
O I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner
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. Company
❑ 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 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 wbuilding 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.
I agree to comply with all city and county ordinances and slate 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
HARD COPY
TOTAL
REMARKS .
�yr•� .�fitt `` y} -gyp z•' '" ,
i7, -• s•'L�1.�vS1. :: L �: i iii.
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 b Y:.
ISPECtTOR
Date 4f 25`8 Permit
.Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SO. 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
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 APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
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 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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
CVIVA JJI.- IYRCJ/-I LQI
GARDEN WALL FINAL
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