11272 (RPL)P.O. BOX 1504 M o . 1,12 7 ` .
Building 44u35 Safxo�+� 78-105 CALLE ESTADO
Address A� LA QUINTA, CALIFORNIA 92253
Owner
George Goldman
BUILDING: TYPE CONST. OCC: GRP.
Address
Mailing, same as above
- A.P. Number
City Zip Tel.
La QuIn ta 92253 Legal Description
Contractor Project Description
Owner I BLii leer
Address ADO u�a Spa
City Zip Tel..'
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
Arch.; Engr., -
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and
effec
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated. Valuation
I hereby affirin that I am exempt from the Contractor's License Law for the following.
reason: (Sec. 7031.5,Bushiess and Professions Code: Any city or county which requires a %
00
permit to construct, atter, improve. demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed. pursuant to PERMIT - AMOUNT '
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 - Plan Chk. Dep.
subjects the applicant to a chd penatty of not more than five hundred dollars.($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan. Chk. Bal. 52.65
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. a n
Professions Code: The Contractor's License Law does not -apply to an owner of property who 3 + . 0 V
builds or improves thereon and who does such work himself or through his own employees. Mech.
provided that such improvements are not intended or offered for sale. If, • however, the building Q0
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 45.00
%proving that he did not build or improve for the purpose of sale.) .
O; I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 27.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property -who builds or improves thereon, and who contracts for : S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) "
Grading
O 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.
-91 �, I ,-��E'� :a , � Infrastructure
Date Owner �
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) -
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.tsJ$';,"¢, #�I �QO~"F°r i4
TOTAL 230.25
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
orless.)
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 Owne� ,�.
NOTICE TO APPUCAM.'y after making this Certifiicatelo%'Exemption you-•gJmould become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith -
comply with such provisions or this permit shah be deemed revoked. Minimum Setback Distances:
Front Setback fron Center Line
Rear Setback.fron- Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setbadk from Center Line
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.) 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 FINAL DATE IN 3PECTOR
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. Issued by: Date Permit
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. Validated by:
Signature of applicant_ Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT. ®YARD
ROUGH PLUMB.
SPKLR SYSTEM ,
POR. SQ, FT, ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. F.. Q
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT. ®
GAS (ROUGH)
DRINKING FOUNTAIN.
SQ. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
GROUT
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
'::H FER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(OISH) — -•
APPLIANCE DRYER
GRADING
cu. yd.
plus x$
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. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
==F—
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
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
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.
FRAMING
FINAL INSP.
ROOFING
fly, ✓
/
/
�j�/
�/ % �Z14
7 [/
REMARKS:
VENTILATION
FIRE ZONE ROOFING :
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
I, r
TA
-P.O. Box 1504
16105 CALLE ESTADO
LA OUINTA• CALIFORNIA 92253
Contractor r� /. Owner Co 4-ff
Address Job Address G(4/-�-
La Quinta City License No.: Expires: Bldg. Permit No.:ZZC
r
This form -shall be posted on the job with the Building Inspection Card'and it
shall be the duty of the General Contractor or if Owner -Builder Permit, the owner.
to see ,that all sub -contractors sign this card, giving his City of La Quinta-
Bgsiness•License Number, Contractors License Number and a current certificate
of workman's Compensation Insurance Certificate when he starts the job. Failure
to comply may cause Building Inspectors to stop work, or complaints to. be filed
against such contractors or owners. .
CITY CONT.
SUB -CONTRACTORS , NAME` LIC. NO. EXPIRES LIC. NO. EXPIRES
Grade i Excavate
2• Pipelines
3•- Cement -Foundations
4. Cement Walks a Drives.
5• Asphalt paving
6: Framing
7- Steel Structural
Masonry
lam!
Plumbing
{
10. Lathing
Ll. • Drywall -
.Plastering '
13. HVAC
Electrical
15. Roofing
l6 .'..Sheet Metal
L7. Floors -All Types
18. Glass - Glazing '
19- Insulation/Weatherstrip
20.. Sewage Disposal
21•' Painting/Decorating
2
• Tile
3• Cabinets -Installation
24• Ornamental•Metal
25. Fences/Blockwalls
26. Landscaping
27 Others
---
DO NOT'REMOVE THIS CARD
Before Final Building Inspection Will Be Made
.. m�.: _ r+,., �... U..e� Oo I"...�..\��nA '•+nA Ct l,�p q7i �1. T:wl.i 1� r�_�,•-.. _�.7 �� e.. ..