07562 (RPL)P.O. BOX 1504 N 4 .
Building 45-415 R+9adX'i mer 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Mailing
Address $fes
City
La Mita
Contractor
Swe
Address
City
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
AP McCue ~ h BUILDING: TYPE CONST. CCC: GRP.
F A.P. Number 617-142-013
Zip Tel.
92253- , Legal Description
Project Description Peal & Som
Zip Tel.
07562'
City
Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
Tel.
l
New ❑ Add ❑ Alter ❑ ' Repair ❑ Demolition ❑
City
Zip
State
Lic. #
Distances:
1TV'
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.
w4
Rear Setback frorr Rear Prop. Line
_SIGNATURE DATE .-
Side Street Setback from Center Line
OWNER -BUILDER DECLARATION
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
orimprovement-is-soldwithin one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
O I, as owner of tiie.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. _ 8. & P.C. for this reason
Side Setback from Property Line
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
DateOwner. <.n - ^. •�
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
TOTAL
WORKERS' COMPENSATION INSURANCE REMARKS Y an ITJF
(This section need not be completed if the permit is for one hundred dollars ($100) valuation S.Vv�y a v
all
fat, I zt-14..C).
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 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 if 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 -
ZONE:
BY:
Minimum Setback
Distances:
1TV'
Front Setback fron Center Line
w4
Rear Setback frorr Rear Prop. Line
Side Street Setback from Center Line
WORKERS' COMPENSATION INSURANCE REMARKS Y an ITJF
(This section need not be completed if the permit is for one hundred dollars ($100) valuation S.Vv�y a v
all
fat, I zt-14..C).
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 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 if 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 -
ZONE:
BY:
Minimum Setback
Distances:
Front Setback fron Center Line
Rear Setback frorr Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
4/17/94
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ, FT, ®
GAR. SQ. FT. ®
CAR P. SQ. FT. ®
WALL SQ. FT. ®
SQ. 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
STORAGE TANK
FLOOR DRAIN
MECHANICAL FEES
DUCT WORK
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REINF. STEEL
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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.
SQ. FT. ® c
BATH TUB
SQ. Fr. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SQ.FT.GAR ® V4c
HOUSE SEWER
FIREPLACE
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. CJ BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) S if METER LOOP
FF
HEATING (FINAL)
OTHER APPJEQUIP.
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. 76 0
FRAMING
FINAL INSP.
ROOFING
v/
/
y
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