003505 (AR)Building
Address 53—
Owner
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 688 Mildred
City Zip Tel.
I1arina Del. Rey. 90291
Contractor
Address
City Zip Tel.
State Lic. City
& Classif. Lic. #
Arch., Engr., -
Designer
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
I hereby affirm that I am exempt from the Contractor's License Law for the following
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 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) or n
Division 3 of the Business andProfessionsCode, 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). . . -
0 I, as oner 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 of 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.) -
❑ 1, 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.)
❑ .1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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. ❑ 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 or 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 a building 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 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
HARD
No. 003505
BUILDING:. TYPE CONST: . OCC: GRP
A.P. Number 774-153-008
Legal Description
Project Description Add 75 Sa+ ft• of bedroom
and c®nvrerw -.patio into -living area
.add redid deck.
Sq. Ft. No. No. Dw.
Size 766 Stories Units
New ❑ Add CXX Alter ❑ Repair ❑ Demolition O
Estimated Valuation
$201000
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
c;{
Const.
Mech.
7a AA
Electrical
R 1> qA
Plumbing
1 A nn
S.M:I.
r A
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
Ant' W11 d., 7..ni ;-: _ley. nh
A.(1J' LAStf 1*it7IAL - lYi.'.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: IDate1/38%07Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINC�'FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. 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 as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FG/CFORMS „ F
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.IEQUIP.
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.
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/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ECT. FEE
EL
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK'
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
WSLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FG/CFORMS „ F
SEWER OR SEPTIC
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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 ;� . 2 {
�1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
/ CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
Q
TO: City of La Quinta DATE:
Department of Community Development
05 Ca11CAEstado NOTICE: THIS DOCUMENT CANNOT
La Q
BE DUPLICATED.
n - A
This is to -certify hat
developer of which is
located at -O , within
this District, has paid school facility fees imposed pursuant to the
authority genek4Y by Govern ent Code Section.53080 the a unt of
$ 3 eZ� ( �-
covering a total of square fee of (N -.4 --residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
r -
for D SERT SANDS•UN I D SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
OCtlqi3 (10)-37