10787 (PLBG)444
P.O. BOX 1504 No. 10787
71;105 CALLE ESTADO i
Building 52-975 Ave Ramirez �f
Address LA QUINTA, CALIFORNIA 92253 t
Owner
tris Nora Carranza
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address Sarae A.P. Number 773-322--922
City Zip Tel.
La Quinta 9223.3 1 Legal Description
... L. W-1-1son Construction
P. C. Box 1687
city. ndi.o zip92201 Te1.:342--2322
State Lic. City
& Classif. 52.9319 Lic. #
Arch., Engr.,
Designer
Address ITel.
City(Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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 - f DATE
OWNER•BUODER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law.for the following
reason: (Sec. 7031-5,8shess and Professions Code: Any city or county which requires a
permit to constnra, after, urmrove, demolish, or repair any structure, prior to its issuance afro
requires the applicant for such permit to Me a signed statement that he Is licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of -
Division 3 of theBusiness 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
'sub)ects the appf ant to a o0penalty of not more flan five hundred dollars ($500).
❑ 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
Professions Code: The Cantractors License* Law does not apply to an owner of properly who
txnlds or mnproves thereon and who does such work himself or through his own employees,
provided that'surh krmrovemems are not intended or offered for sale. If, however, the bulldmg
or ormrovement is sold within one year of completion, the owner-bullder will have the burden
or proving that he did not build or 6ryvove for the purpose of safe.)
❑ I, 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 propertywhobur7ds or improves thereon, and who contracts for
such projects with a contracrogs) licensed pursuant to the Contractor's License Law.) -
0 1 am exempt under Sec B- & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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 r7 file pervt 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 owned
NOTICE TO APPLICANT: U, after making Otis Certificate of Exemption you should become
sukect to the Workers' Compensation provsions of the Labor Code, you must forthwith
comply with such Provisions or this pemhit 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• Ciel Code.)
Lender's Name
Lender's Address
This is a building permit when property filled out; signed and validated, and is subject to
expiration it work thereunder is suspended for 160 days.
I certify that 1 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
Project Description
Sewer Hook 7p
Sq. Ft. No. No. Dw.
Size - Stories Units
New ❑ Add-❑ Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation 1,700
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing 30.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL 30.00
REMARKS 7A8_A13
A13
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: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. Fr. ® $
2ND FL SQ. FT. ®
FOR. SO, FT, ®
GAR. SO. FT. ®
CAR P. SQ. FT. ®
WALL SQ. FT.
SO, 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH) _
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® V4c
HOUSE SEWER
FRAMING
FINAL INSP.
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 PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER ��
OUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINTTIALS
GARDEN WALL FINAL