14434 (SATT)4
P.O. BOX 1504
Building 78 495 CALLE TAMPICO
Address 48-640 Paseo Tara2Q LAQUINTA,CAL
ownelRogar Snf611e*nberger & associates
Mailing
Address 55-6950 P3bble Beach
CityZip Tel.
.._La Quinfia,'. C%� 92253 4619)-777-17767
Contractor
._ Same,
Address. .
City Zip Tel.:
State Lic. I City
& Classif.. 13 488234 Lic. # 1.858
Arch., Engr.;
Designer Cii:los .Elias Engrineeil:
Ad. j25, Charle>swor h Dr. T11619) 328--72'71
Cieathedral Cit'Zrp CA 924234 Lic.t#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that �.amdieensed�uhderprovisions of Chapter 9 (commencing v}�th Se 'tion
7000) of Division)3 of the Businessland krofessions Code, and my license i rn fell f r and
effect: �v `r
$1GNATURE t+� �7 1 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 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
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 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, 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 enprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to.corr,
'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) jlcensed pursuant to the Contractor's License Law.)
O.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. 3800, Labor Code.)
Pollicy�o. Company
t® Copy is filed with the.city, ❑ 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.) '
I certify that in the performance of thV work for which this permiVis 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. - N, after making this certificate of - Exemption you should become
subject to theWorkers' 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 TOCRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000),1N ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INT ST, AND
ATTORNEY'S FEES.
This is i building permit when property filled out, signed and validat d, 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 • formation is correct.
I agree to comply with all city and county ordinances'and'state 11 s relating to building
construction, and hereby authorize representatives -of this city) to enter the above..
mentioned property for inspection purposes.
IFORNIA 92253
No. 14434
11LDING: TYPE CONST. •VN OCC: GRP.
646-08-21-040
40
P. Number
Lot 66 Tract 20052--4
!gal Description
SFS? 'Pisan .5
oject Description
Laguna De La Paz.
REMARKS
ZONE- '
BY: '
Minimum Setback
Distances:
Front Setback from Center Line
Sq. Ft.
Size 2001 -
No
Stories-
No. Dw.
-Units
New ❑ Add ❑
Alter ❑ Repair ❑ -'Demolition ❑
Side Setback from Property Line
FINAL DATE
Issued by:
Validated bv:
INSPECTOR��
—Date --,,X4 Pert
��C>
Estimated Valuation
$115031.20
PERMIT'
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
585.92'
Const.
695.5
Mech::
62. g.0
Electrical
142.52
Plumbing'
150.00
S.M.I. '
11.60
Grading
20.00
Driveway Enc.
00 r..
Infrastructure
2,452.58
Arts In Public
Places
30.32
-------------
TOTAL
4,158.44
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
FINAL DATE
Issued by:
Validated bv:
INSPECTOR��
—Date --,,X4 Pert
��C>
Signature of applicant Date
Mailing Address Validation:
City, State, Zip 1
tP
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. BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (FINAL) 4 1
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 ® 1Ve c
SEWAGE DISPOSAL
REMARKS:
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
GROUND PLUM UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI ff ROUGH WIRING
DUCT WORK,
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) 3 METER LOOP
77
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL) 4 1
J TEMP. POLE
/
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
�y
FRAMING 7
D
ROOFING
] _ � � � �
�Q
t
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL