14543 (SFD)TAh•
4
P.O. BOX 1504
No. 14543
`4 Building
Address `' 48-621 Paseo araz0 LA QUINTA, CALIFORNIA 92253
Romer 5nellenberger >& Associates
Address 41-865 Boardwalk 0212
City Zip 09)
.
Fara 3eser , 92211 'i77-7766
Contractor
Sartre
Tel::
State Lic. City
& Classif.B 488234 Lic. # 1858
Arch., Engr.,
Designer Carlo" .Elias Engineer
3AB'62.5is Charlesworth Drs gel -9) 328-7271.
City ZiD State
Cathedral city, CA 92234 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of We Business a [a Professions Code Wand my license is in full force and
- effect. �C`-"y�•.�C.{�''7� �`r��.�+tT. � ► 1 ;S '•P'i �"
SIGNATURE 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, after, improve,. demolish, or repair any structure, prior to its issuance also
requires the applicant for suchpermitto file a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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 penally of not more than rive hundred dollars ($500). .-
0 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
of Improvement is sold within one year of completion, the owner -builder will have the burden
or proving that he did not build or rrlprove for Ne 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 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 ciintractoi(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
WPoipy
'Co
ensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Companyled with the city. O.Certified copy is.hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any parson in any manner so as to become subject to the Workers' Compensation
Laws of California.
bate - Owner
NOTICE TO APPLICANT: If, after making this- Certificate of Exemption you should become
subject to the Workers' Compensation provisions or 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
;i building permit when property filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 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
BUILDING: TYPE CONST. VN.- OCC: GRP. R3
A.P. Number 646-082-01.1
Legal Description Lot 37 'bract 20052-4 .
SPD
Project Description an 2
Laguna Ds La Paz
TOTAL - 4,152.64
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft. 19+50 No.
Size Stories
No. Dw.
Units
New ❑ Add ❑. Alter ❑
Repair ❑. Demolition ❑
Side Street Setback fcom;Ge ter Line
e t
Side Setback from P perty Line�'� -
FINAL DATE�
IN�PECTOt
Issued by:,
Date �\ P4r�iit \'
Validated by:
Estimated Valuation $111,392.00
PERMIT
AMOUNT
.Plan.Chk. Dep.
Plan Chk. Bal.
r-75.52
Const.
661.50.
Mech.
62.00
Electrical
140.95
Plumbing
.150.00,
S.M.I.
11.20 ..
Grading
20.00
Driveway Enc.
00
Infrastructure
2,482.99
Arts in -Public -Places
28.38
TOTAL - 4,152.64
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line ..
Rear Setback from .Rear Prop Line
m—
Side Street Setback fcom;Ge ter Line
e t
Side Setback from P perty Line�'� -
FINAL DATE�
IN�PECTOt
Issued by:,
Date �\ P4r�iit \'
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING. FEES
IST 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
FLOOR DRAIN
MECHANICAL FEES
STORAGE TANK
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FOUND. REINF.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
HEATING (FINAL)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
LUMBER GR.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
'!
/
SO.FT.GAR ® 3/4c
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE 111PL.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. A 09 BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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 Ij% �J
FINAL INSP.
ROOFING zkf
'!
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 0
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL