003485 (RPL)Ti444
AV
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 77-615 rortero LA QUINTA, CALIFORNIA 92253
Owner
WaitZkK.an
Mailing
Address Sam as above
City Zip Tel.
La Quinta. 92253.
Contractor
P Psx101
.Address .
No. 003485
BUILDING: TYPE CONST. W4 OCC: GRP.•
A.P. Number 774=30--!,4
Legal Description
Project Description Pool A npi
78-755 114artincue
BY:
Minimum Setback Distances:
City ..
Zip"
TeL'.
A.S�-S lO
Rear Setback from Rear Prop. Line
State Lic.
& Classif. 476807
City
Lic. #
Sq. Ft.
'Size
No. No. Dw.
Stories - • Units
'
Arch:, Engr.,. ._ ...
-.Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
Validation:
City
Zip
State
Lic. #
'
.. _ LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that,l ain licensed under provisjonsrof Chapter 9 (commencing with Section
7n,3 of 000) of Divisiothe Businessrand Professions`Code, and my license is in full force and
effect.. r� ^ --
... ,
.. ..
.... .
-.-. F f,r ._ .. _� ltr w . ..
SIGNATUREDATE
DATT E
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 Vol the Business and Professions Code, or that -tie is exempt therefrom, and they 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 fmprovements are_ not intended or offered for sale. If, however, the building
or improvement is sold within one year or completion, the owner -builder, 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 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) licensed pursuant to the Contractor's License Law.) -
❑ I am exempt under Sec. B. 8 P.C. for this reason
Estimated Valuation
$a,'�
.. PERMIT
AMOUNT
Plan Chk. Dep.
-
Plan. Chk. Bal.
$60.12
COf1St.
�0 ,
Mech:
.
Electrical
36 ��
Plumbing
14.00
S.M.I.
._ .
^ '
Grading
Driveway Enc.
Date owner
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
❑ Copy is filed.with the city.. ❑ Certified.copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, 1 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. If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, 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 it 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 Date
Mailing Address
City, State, Zip
HARD COPY
TOTAL
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
INSPECTOR
-Issued by:
'
Date 'Permit.
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT. ®
POR. SQ. FT. p
GAR. SQ. FT. ®
CAR P. SQ. 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 ss property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FANi EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
REMARKS:
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.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
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
AS (FINAL)/. 7r—
I
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
�(� /74-
tFIREFIRE
REMARKS:
VENTILATION
ZONE ROOFING
FIREPLACE
PLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL