15246 (AR)t � • rI ,
r P.O. BOX 1504 No. 15246
Building 52_8 fly AVO. Bermudas LA QUINTA, CALIFORNIA 922253
Address
Owner t:
Mailing
Mike Lorena Ar ante BUILDING: • TYPE CONST. OCC: GRP.
Address Same
A.P. Number
City Zip Tel.
}gym [lti 111 Gd9a l -ii 1 '4 LI. :11 1 _'
Contractor
ThtE 9tity Construction
Address _
59-705 Ave. Carranza
city Quinta, CA
zip 92253
Tel' 64-1279
State Lic.
City
& Classif. 621156
Lic. # 2968
Arch., Engr.,
' Designer
Address
Tel.
City r Zip State
/ Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
*i, ).of Division 3 of the Business and Professions Code, and my license is in full force and
effect. -
$LGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law for the following
reason: (Sec. 7031.5,13usiness and Professions Code: Any city or county which requires a
permit to construct, after, 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) of
lEsion 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 penally of not more than 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, Suisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds orsmpr6ves 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.)
O 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 property who builds or improves thereon, and who contracts for
such projects with a cOntractor(s) (rcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
i -
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. 31700, Labor Code.)
Policy Njo! Company
Dopy 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.)
m' 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.
I Datea• -- •- owner
NOTICE TO APPLICANT: 11, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
i 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 180 days.
1 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
j construction, and hereby authorize representatives of this city to enter the above-,
l mentioned property for inspection purposes,
Signature of applicant Date
Mailing Address
City, State, Zip
,Legal Descrlptlon
Project Description Room Addition
Sq. Ft. No. No. Dw.
Size .320 Stories Units
New ❑ Add ❑ -Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $17,736.00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const. r
Mech.
Electrical
Plumbing ,
S.M.I.
Grading,
Driveway Enc.
Infrastructure
TOTAL
REMAR
IAMOUNT
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
Validated
Validatior
W,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE 3
2ND FL. SO. FT. p
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
OTHER APPJEOUIP.
DRAINAGE PIPING '
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
-$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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 -7 A
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 3
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 7 f%S
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL %5
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
FINAL INSP.
FRAMING G
FINAL INSP.
ROOFING
-/xo
/,
f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION Q�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
:rtirc;e 31 kaamPiiancr: Residential
olect Title
olect
ocdntentatlon Author
-)mbtlance Method t
1ENERAL INFORMATION
.otal Conditioned Floor Area:
'_wilding Type: ✓
:neck one or more
=font Orientation:
number of Dwelling Units:
=loor Construction Type:
vstem
Zone
3 2D ftz
Single Family ✓ Addition
Multl-Fa Existing -Plus -Addition
North Ea / South / West / All Orientations
(Input on anon in degrees and circle one.)
Slab Raised Floor (circle one or both)
3UILDING SHELL INSULATION
(Pace . of 2) CF -1 R
Date
6uddmq rermit u
Plan LnecK i Date
Field GheCK I Uate
Enforcement Agency use uniy
Stab Edge
FENESTRATION Shading Devices
Fenestration Area Fenestration Interior Exterior Overhang Framing Type
Orientation (st) LI -Value (roller blind. etc.) (shadescreen. etc.) Ives/nol (metal/wood/vinyi)
Front..... ( )
Front.., .. ( )
Left....... (5) t S �—
.�75 �.✓ Pi {�(1 r�REaU
Left ....... ( )
Rear ..... ((k)) �f)— ,75 co ev in Ah
Rear ..... ( )
Right..... ( )
Right.....
Skylight .......
Skylight .......
T HERMAL MASS
Type/Covering Area Thickness
slab/exoosed. tile. etc.) (st) (inches) Location/Description (kitchen, batn. etc.
Uwteed January 1292
ffli A a
�. — - - —
. Construction
.;omponent
Insulation Assemoly LocatiorvComments
fype
R -value U -Value (attic. to garaye, ryotcal, etc.I
Wall ...............
f2--13 TYPIC -L WA L -L-
Wall ..............
Root .............
Root .............
Floor .............
Floor .............
Stab Edge
FENESTRATION Shading Devices
Fenestration Area Fenestration Interior Exterior Overhang Framing Type
Orientation (st) LI -Value (roller blind. etc.) (shadescreen. etc.) Ives/nol (metal/wood/vinyi)
Front..... ( )
Front.., .. ( )
Left....... (5) t S �—
.�75 �.✓ Pi {�(1 r�REaU
Left ....... ( )
Rear ..... ((k)) �f)— ,75 co ev in Ah
Rear ..... ( )
Right..... ( )
Right.....
Skylight .......
Skylight .......
T HERMAL MASS
Type/Covering Area Thickness
slab/exoosed. tile. etc.) (st) (inches) Location/Description (kitchen, batn. etc.
Uwteed January 1292
ffli A a
�. — - - —
Certificate of Compliance: Residential
(Page 2 of 2) CF -1 R
Prolect Title
Daq
J
HVAC SYSTEMS
'
Note: Input hydronic or combined hydronic data under Water Heating Systems. except Design Heating Load.
Distribution
Heating Equipment
Minimum Type and Duct or
Type (furnace, heat
Efficiency Location Piping Thermostat
oumo. etc.)
(AFUEJHSPFI (ducts/attic, etc.) R -Value Tvoe
Cooling Equipment Minimum Duct
Type (air condRioner. Efficiency Location Duct Thermostat Configuration
heat oumo. evao. coolina) (SEER) (attic. etc.) R -Value Type (split or oackc
WATER HEATING SYSTEMS
Water Heater Distribution
Type Tvoe
--""15rIN6r
1. For small gas storage (rated input s 75,000
For large gas storage water heaters grated
For Insuntansous gas avatar
mem. list F
SPECIAL FEATURES/REMARKS
Ratprit Tank
C0- vVt,P
COMPLIANCE STATEMENT
This certificate of compliance lists the budding
the California Code of Regulations. and the ad
individual with overall design resoonsltulity. W
orientations; any shading feature that is vaned
Deslgner or Owner (per Business fit Professions Cade)
Name:
Tide/Firm:
Address:
Telephone:
lac. 8:
(signature) (date)
Enforcement Agency
Name:
Tide:
Agency:
Telephone:
(stpnatureistamp) .(date)
Review January 1992
Energy External
F7rfnr nr Tank
'Standby' Insulation
Loss (%) R -Value
list Energy Factor.
and Standby Loss.
1 win Title 24, Parts 1 and 6. of
,has been signed by me
jallding plan to be built in multiple
Documentation Author
Name:
Tide*'"":
Adtess:
Telephone:
(signature) (dam)
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
N®TICE: THIS D6dUMS . A'Y FEES
BE DUPLICATED,
TO: City of La Quinta DATE:�'—
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that
developer of , which is
located at ®S ► within
this District, has paid school facility fees imposed pursuant to the
authority generated by Government o e Section 53080 in the amount of
194 ff(L�
covering a total of square feet of (A res dential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
Tat- agooz� x 960 = 6u&"/ ,0 . e
a4D N b ' for'DESERT SAbtS.UNIFIED SCHOOL DISTRICT
White -- Building Department • f,Y,ellow - Facilities Planning • Pink - Accounting • Gold - Developer
T' v
l'4'— ; g� (3 g l!/ (10)-37