003161 (BLCK)r
Building
Address 51--475 Calle Rondo
Owner .
pfvnprk R. ye.P.Av4ars
Mailing
Address• 0• Box 253
City Zip
.Ls Ouinta— ... 92253
Contractor
f��rsralr i`t'rsd 1 �3ar
Address
Twit 4 QUM&'
P.O. BOX 1504 No. 003161
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP'.
A.P..Number 769-I1►><c•-014
Legal. Description
Project Description Ls5 Vit. cxg '�.�nrzr# 1r�
City _.
Zip
Tel.'
State Lic.
City
& Classif..,
Lic. #
Sq. Ft.- '
No. No. Dw.
Size
Stories - Units
Arch., Engr.;
Designer
New ❑ Add ❑
w
Alter ❑ Repair ❑ - -Demolition ❑.
Address
Tel.
City
Zip
State
_ .
Lic: #
LICENSED.CONTRACTOR'SDECLARATION.
��•
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. _ ... ..
... ... _. ...�..
.. .. .. _ .. .. .. .
. SIGNATURE DATE
' OWNER -BUILDER DECLARATION
hereby affirm that thaam 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,, priorto 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.thbrefiom, and'the basis..
-for the alleged exemption. Any violation of Section 7031.5. by 'any applicant for a permit
Estimated Valuation
c
i •
'^PERMIT
. .
• - AMOUNT
Plan'Chk.- Dep.'..
subjects the applicant to a'civil penalty of not more than rive hundred'dollars ($500).-
$500):❑ I, as owner of the property, army employees with wages as their sole compensation, will
0
Plan. Chk. Bal.
_
Const..
$44550
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 loran owner'ot property who
'such
Mech. - ..
-
• builds or improves thereon and who does work himself -:or through his own employees,
provided that such improvements are not intended or offered for, sale. If, however, ,the building ,
EI2CtrICdl
.
'
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.)
Plumbing
"
.O 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
S.M.I.
_
-
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) • -•
❑ I am exempt under.Sec:. B. ti. P.C. for this reason
Grading
Driveway Enc.
Date - 7flC 7 owner 1� - ' -R --r •-, -
Infrastructure
WORKERS' COMPENSATION DECLARATION
' V 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 -
..
0 Copy,is,filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
MAO
CERTIFICATE OF EXEMPTION FROM
WORKERS'.COMPENSATION INSURANCE
REMARKS
t
' n .r.01; Sd z t> ^-•i ;. . - v, v wv a
i 61.IM
(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 tha 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. '
__
ZONE: BY:
Minimum Setback Distances: ' '
Front Setback.from Center.Line
'
Rear. Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
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.)
Side Street Setback from Center Line"'
Side Setback from Property Line
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.
FINAL DATE
INSPECTOR
1 car ify -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.
, Issued by:
-
Validated by:
° Date A / 14IA7 Permit
- •- -
Signature of applicant -Date-
ateMailing
MailingAddress
Validation:
City, State, Zip '
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT.-®
GAR. SO. 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
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
DUCT WORK
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SERVICE
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
I 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
SEWER OR SEPTIC 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
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
Ed-
ft
°n$7
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
-SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL