003615 (AR)TA hf
P.O. BOX 1504 No. 003615
Building 78-105 CALLE ESTADO
-Address 53-5520 Rubio LA QUINTA, CALIFORNIA 92253 ^
Owner
Neal A Naren praaer BUILDING:, TYPE CONST. - OCC: GRP.
Address 0. - 774-113-002
002
�•®sY. 5�3 A.P. Number
City. Zip Tel.
La Ouinta ' 92253 Legal Description
Project Description
Contractor Extend kitchen and bathroor
- , .
owner/bmilder
Address .. , nd change flat -roof to pitch roof.-
City
oof.-City lZio Tela '
State Lic.
City
& Classif.
Lic, #
Sq. Ft.' ,.
No. No. Dw.
Size, `,
Stories Units
Arch., Engr _
Designer
New ❑ Add ❑
Alter ❑ 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
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
'.
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
3 1 '
$8,331
reason: (Sec. 7031.5,Business and Professions Code: Any -city or county which requires a
peimif to construct, after, improve, demolish, or repair any structure, prior to its issuance also
s
,-requires the applicant for such permit to file 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) o/
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the Any Section 7031.5 'any for
Plan Dep.
,
alleged exemption. violation o/ by applicant a permit
' subjects the applicant We civil penalty of not more than five hundred dollars ($500). -
.Chk.
Plan Chk. Bal.
848. 44
❑ 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.
���
Professions Code: The Contractor's License Law does not apply to an owner o/ property who
w
builds or improves thereon and who does such work himself or through his own employees,.
Mech.
- 10.00-
provided that such Improvements are not intended or offered /or sale. I/, however, r the building
or Improvement is sold within one year o/ completion, the owner -builder will have the burden •
Electrical1�
o/ 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
of)
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 •%r
S. M: 1:
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
_
• ❑ I am exempt under Sec. . B. 8 P.C. for this reason
Driveway Enc.
Date 1 - fr `Owner--.-:' *+
Infrastructure
WORKERS' COMPENSATION DECLARATION
' I hereby affirm 'that J 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.
,
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
r
_ WORKERS' COM PENSATIONINSURANCE
(This section need not be completed it the permit is for one hundred dollars (5100) 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.
��. }„ A,
Date Owner"
o
NOTICE TO APPLICANT: If, after making this Certificate o/ Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be 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, 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 i's subject to
expiration if work thereunder is suspended for 180 days.
2� /g(ti
I certify that I have read this application and state that the above information is correct.
*all
Issued by:
Date ! C7 Permit
agree to comply with 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
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SO. FT. ®
GAR. SQ, FT. ®
CARP. 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
WATER PIPING
NOTE: Not to be used asproperty tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
F RM L Q
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL 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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
Y
'
SQ.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TO -IAL 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 PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
F RM L Q
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 31, 11 /
FINAL INSP.
ROOFING 3 /
Y
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
'? INSULATIONISOUND—c
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
OW5 blUNA I UHES/INITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
TO:.City of La Quinta
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
. OT
DATE:
U 0c ' en.
This is to certify th';t� o ��
developer of / which is
located at 5 — within
this District, has paid school faci'lity fees im •sed pursuant to the
authority generated by Government Code S.,eectiott 53080 the amount of
covering a total of square feet of (1, -)-residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
for DESERT SANDS UNIFIED PCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning%• Pink - Accounting • Gold - Developer
`�� 33 (10)-37