11614 (GRES)P.O. BOX 1504 No. 11614
Building 78-105 CALLE ESTADO
Address 50-645 Calle Quito LA QUINTA, CALIFORNIA 92253
Owner
Mailing
u ..D. sees lits BUILDING: TYPE CONST. OCC: GRP.
Address Same A.P. Number
City Zip Tel.
La 4'_),uinta. -CA 92253 1 564-3877. Legal Description
Contractor Project Description Ga$1q$
Owne Suild er
Address
City Zip Tel.:'
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Size 4158• . Stories Units
Arch., Engr.,
Designer New ❑ 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 Division 3 of the Business and Professions Code, and my license is in full force and
effect.
_SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following $ 8 p 564. 40
reason: (Sec. 7031.5,Business and Professions Code: Any city or county. which requiresa
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 PERMIT- - AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of -
Division 3 of the Busiriess 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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation; will Plan Chk. Bal. ' . 70-20
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and 108.00
Professions Code: The Contractor's License Law does not apply to an owner of property who" Const: i
• builds or improves thereon and who does such work himself or through his own employees,
provided that' such improvements are not Intended or,offeredfor sale. If, however,. the building Mech. .�
`
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical t a
f 1 .38
of proving. that he did not build or improve for the. purpose of sale.)
64—' as owner of the property, am exclusively contracting with licensed contractors to con.. Plumbing
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 S.M.I. .90 •
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C: for.this reason
l Driveway Enc.
.Date �"`' v' � <Owner � �!-R ..-:'tx�.�...�:.•-��,a _-•�--�-...,,�-,� Infrastructure
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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 234.48
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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 the work for which this permit is issued,.l shall not
;i%{+r� l y -� 14'f;
employ any person in any manner so as to become subject to the Workers' Compensation
' Laws of California.
Date Owner
NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' 'Compensation provisions of the Labor Code,- you must forthwith -
- comply with such provisions or this permit shall be deemed revoked.
-
Minimum Setback Distances: '
-- -
Front Setback fron .Center Line
Rear Setback frorr Rear'Prop Line
CONSTRUCTION LENDING AGENCY
_
Side Street Setback from,Center Line
�'f , hereby affirm that there is a construction lending agency for the performance of the
woWfor which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line -
Lender's Name
Lender's Address
This is a building permit when properly filled out, sighed and validated, and is subject to
FINAL DATE
INSPECTOR
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. •
Issued by:
Date Permit
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL., SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. 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
ROUGH PLUMB.
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
GAS (ROUGH)
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING q
L
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
FORMSAy
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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.4 21—V
FRAMING J% Lv
FINAL INSP.
ROOFING q
L
_/� 3
SUCH
a3
!>
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FI WALL
LATHING ��✓ !J
MESH
INSULATION/SOUND 3
FINISH GRADING
FINAL INSPECTION- ( ) 3
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL
CUNCATICiv
24 X 36 PRINTED ON NO. 1000H CLEAR PRINT*
LEF T
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CITY OF LA QUI"'TA
NI.
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
hdoDATE By