9954 (RPL)V
Building
Address ss .44-120 CALICO
Addr'
Owner
4
P.O. BOX 1504! ` N o .
7&105 CALLE ESTADO \-�
LA QUINTA, CALIFORNIA 92253
MR. & MRS. DEDDERMAN
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address SAME A.P. Number
City Zip ]Tel.
LA QUINTA 192253 Legal Description
Contractor Project Description PO,L AND SPA
DATE PALM ENTERPRISES
Address
28070 PRIMAVERA
City Zip Tel.:
CATHEDRAL CIPF'92234 325-2187
State Lic. City
& Classif. C-53591925 Lic. # 1858 S4. Ft. No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer ' New El '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 Division3 of the Business and Professions Code, and my license is in full force and
effect-- "A /f i• - Y - J ¢"
SIGNATURE •/ I ./ DATE'
OWN Efi-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, atter, 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 or the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
Division 3 of the Business and Professions Cade, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any epp5cant for a permit
subjects the applicant to a civil penalty of not more than five hundred dogars (5500).
❑ 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 or 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 safe. N, however, the buildingor improvement is sold within one year, or completion, the owner-buider 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 con-
' struct the project. (Sec. 7044, Business and Professions Code: The Contractors 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, N6. .Company -
/' o y 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 (5100) valuation
or less.)
I certify that in the perormance•of thF work for which this permit is issued, I shall not
employ any person in any manner so asrto become,subj6ct to•the Workers' Compensation
I �. r.rgni a t_r 0, —'r . f
Date r!� '/ Owner(/11
NOTICE TO APPLICANT. -_If, _afler�makmg this Certificate oL„Exemption you should become
subject to the Workers' Compensation provisions of the` U66r—bode, 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 v Date
Mailing Address
City, State, Zip
Estimated Valuation
$12,00
PERMIT '
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$93.60
Const.
14 4.00
Mech.
24.00
Electrical :
45.00
Plumbing
27.00
S.M.I.
1.30
Grading
Driveway Enc.
Infrastructure
r
1 t m
TOTAL
1334.90
REMARKS
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 d
FINAL DATE INSPECTOR
i
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL SQ. FT.
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP. Q 4r w"
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
SPARK ARRESTOR
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 PLUMBINGq OUNDERGROUND
514
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
v
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. Q 4r w"
FRAMING
8 Lll �
FINAL INSP. I-
rd
ROOFING
cap �i�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION- 0 (�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
T4ht °f 4Qkwo
P.O. box 1501
7&105 CALLE ESTADO
LA OUINTA. CALIFORNIA 922S7
Contractor
Owner 1k
{,e/ryC�JLyx-i
Address
Job Address
`-� �— 0
-
La Quinta City License No.: /191__iAj Expires: Bldg. Permit No.:
This form shall be posted on the job with the Building Inspection Card and it
shall be the duty of the General Contractor or if Owner -Builder Permit, the owner
to see that all sub -contractors sign this card, giving his City of La Quinta
Business License Number, Contractors License Number and a current certificate
of Workman's Compensation Insurance Certificate when he starts the job. Failure
to comply may cause Building Inspectors to stop work, or complaints to be filed
against such contractors or owners.
CITY CONT.
SUB -CONTRACTORS NAME LIC. NO. EXPIRES LIC. NO. EXPIRES
1 . Grade i Excavate--
2. Pipelines .
3. Cement -Foundations
4. Cement Walks i Drives
5. Asphalt Paving
6. Framing
7. Steel Structural
B. Masonry
9. Plumbing
LO.' Lathing
L1. Drywall
L2. Plastering'
L3. HVAC
L 4 - Electrical•
L5. Roofing
16. Sheet Metal
17. Floors -All Types
18. Glass - Glazing
19. Insulation/Weatherstrip
20. Sewage Disposal
21. Painting/Decorating
22. Tile
23. Cabinets -Installations
24. Ornamental Metal
25. Fences/Blockwalls
26. Landscaping
27.. Others
28.
DO NOT P -MOVE THIS CARD
Before Final Building Inspection Will Be Made
This Form Must Be Completed and Filed With Title 24 Calcs and Plans