10893 (RER)Building
Address 46-770 Cameo palms
Mike Piper
Mailing
Address same
Tsa Quinta 12253
Contractor
Gustafson/Whipple, inc.
Address
P. O. Box 10427
cPalm Desert lzik265
State Lic.
& Classif. 498373
Arch., Engr.,
Designer
Address
City lZip
f LICENSED
I herebv affirm thatrl am licensed
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
735515
Lic. # 1653
IState , ,
Lic. #
i DECLARATION
of Chapter 9(commencing with Section
Code, and my license is in full force and
> OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors 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 lite 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, orthat. 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).
❑ ), 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 safe. ff, however, the building
or improvement is sold within one year of completion,' the -owner-bmtder wig have the burden
of proving that he did not build orxnprove for the purpose of safe.)
❑ 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.)
❑ 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
A6Copy 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 dogars ($100) valuation
or less.) '
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become'subject,to the Workers' Compensation
Laws 9f California. ✓Pt—
Date-5L' LOwner
NOTICE TO APPLICANT: If, alter 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.)
Lenders Name
Lenders 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.
1 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
No. 10893
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description
Remodel
OCC: GRP.
bedroom and living roor,
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
4.y 500
PERMIT
AMOUNT
,Plan"Chk. Dep.
Plan Chk. Bal.
-
46.80
Const.. -
72.00
Mech.
Electrical
Plumbing
.
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
119.30
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. ® $
UNITS
ROUGH PLUMB.
2ND FL. SQ. FT.
HEATING (ROUGH)
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. 0
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
METER LOOP
DRAINAGE PIPING
WALL SQ. FT.
REINF. STEEL
DRINKING FOUNTAIN.
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYEFI
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
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.
SQ. FT. ® c
BATH TUB
SO. Fr. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 V c
SEWAGE DISPOSAL
SQ.FT.GAR ® Vic
HOUSE SEWER
MESH
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
FORMS
SEWC
TANK 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
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING6-1 C,0,/
s
ROOFING
//jam/ ^ C�
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
ING L2cz
MESH
1NSULATIONISOUND
FINISH GRADING
FINAL INSPECTION- /l Vn—
6b
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
ptpe -CGS 7,� -c'
Cc(, 2 2 S_3
Ah
rib o
1 4 - �/ / 9r>
�vSfc�sc�
.
7_7 7 -- S7� t � -
m
PIN
R
4ft's 1 -
wXf - -
m
A v A LA
a ty
CITY OF LA QUINTA.
BUILDIN8 & SAFETY' DEPARTMENT
COM7110NALLY
ACCEPTED FOR COF4,STR
a
UCTION.-
SUBJECT TO INSTALLATION. AS PER
AiD ALL APPLICABLE
't
�X7
�xrsf%H
Svatk
too//
S'
61M
4" x Ox /0` 6 C
•% cl(
1.0v
�X � s �lav� _tt8'X3H' yl'i
U)
Si,je-
171 is
Q/,T(�
ipea,#I
tot f,1,4 (64. 7? PL -3
f^
A r'1
--q&-77o (0,Mvo
x 2e��,��
14e, lei dmr14
Cljf��FLA QuINTA
BUILDIrUG AFETY DEPARTMENT
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
DATE
r f7
vM^
i
J,
4
1-
;r
vM^