15784 (RR)P.O. BOX 1504 '
Building 53a-195 Ave. Ramirez LA 78-495 CALLE , CALIFORNIA ICO
92253
Address
""""" La. Quinta. Palms fealty
Mailing �
Address 51-001 Eisenhower Dr.
CityZip
Tel.
La gainta, �
92253
Contractor
Snyder -Const. Inc.
N'4 She=an, Suite 103
Cjt
8orona, CA
Zip
91720
Tel.:
(909) 279-0770
State Lia
City
& Classif.. B 519797
Lic. #
Arch., Engr.,
Designer
Address
Tel.
.City
Zip
State
Lic. #
LICENSED COO RACTOR'S DECLARATION _
I hereby affirm that I am licensed der D visions of Chapter 9 (commencing with Section
7000) of Div{3 h 3 of the Busines - nd Pr essions Code, and my license' in full fort d
effect.w�
$1GNAT RE 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 rile a signed statement that he is licensed pursuant to
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
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
O 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 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,
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.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to torr,
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) #tensed 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 o. Company
V'Copy is filed with the city. ❑ Certified copy is hereby furnished. .
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed N the permit is for .one hundred dollars ($1.00) 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 ' - Owner
NOTICE TO APPLICANT: If atter 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR ,CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when properly filled out, signed and validated, and is subject.to
expiration if work thereunder is suspended for 160 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
BUILDING: TYPE CONST
Number
Legal Description
Project Description Rer0of
No. 15784
OCC: GRP.:
Sq. Ft. No. " No. Dw.
Size Stories Units
New O Add ❑ Alter ❑ Repair Demolition ❑
Estimated Valuation $3#000,.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. ' u
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center 'in
Rear Setback from Rear LI
Side Street.Setback fr nter Li
Side Setback frorr}. perty Lin
FINAL DATE
Issued by --
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEIN
1ST FL. SO. FT. ® $
2ND FL. SQ. FT. ®
FOR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT. ®
WALL SO. 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
LAUNDRYTRAY
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.
SQ. FT. RESID ® 1Ya c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
_ HOUSE SEWER
'
FINAL INSP.
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
ROCKSTORAGE
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 SIGNATURES/INITIALS
GARDEN WALL FINAL
Inspector
S
BUILDING DEPARTMENT
-.CITY OF LA QUINTA
OFFICE: (619) 777-7012 INSPECTION REQUEST 777-7153
,L
///:-(619)
T �y/� f
DATE:
k
TO: _
ADDRESS:
CORRECTION -NOTICE
PERMIT NO.
AAW
Inspector
S
•
,L
a
Inspector
S