002832 (AR)r .
�gA17-A GIBSULA P.O. BOX 1504. No.. 002832
Building 78-105 CALLE ESTADO
•
Address $ ��" LA QUINTA, CALIFORNIA 92253'
Owner
VMAMM
BUILDING: TYPE CONST:
- OCC. GRP.- '
Mailing'
Address a
A.P. Number
,
City
Zip
Tel. • .
La Ovimt
92253
_
Legal, Description
Project Description
�1L' 4..aY
Contractor
-
_ Address
75-231 Pai Ve
"'City
Zlp
Tel..- _
.mist D
.�.jyy.��...
9LLe10
.
State Lic.
City
& Classif. 498123
Lic. #
Sq. Ft.
Size.. 100
No. No. Dw.
Stories• . Units -
Arch.; Engr., • •
Designer
New R Add ❑ • Alter ❑ aRepair O Demolition ❑
Address
Tel.
City
Zip
State
Lia # ..
LICENSED CONTRACTOR'S DECLARATION
1 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
I hereby affirm that I am exempt from the Contractor's License Law for the following
•_ reason: (Sec. 7031.5,8usiness and Professions Code:. Any city or,county which requires a
permit to construct, after, 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 io a civil penalty of not more than.five hundred dollars ($500).
O 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
• •
Etimatd Valuation
se,
. i SAM
Y
.. -PERMIT
- - •.
e..- AMOUNT
• -.
• Plan Chk.- Dep.:
- - ."
Plan Clik. Bal..
48.42 ,
Const..,
-
e.
-
Mech.'
13.0
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
Electricals -
`.2 �>
or improvement is sold within 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.) _
Plumbing
16.00
O 1, 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.) •
• O I am exempt under Sec.. B: 8 P.C. for this reason
..
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
O Copy is,filed with the city.. ❑ Certified copy is hereby furnished..
TOTAL
164.52
• CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE _
REMARKS
- - -
(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 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, alter making this Certificate of Exemption you should become .
subject "to the Workers' Compensationprovisions of the Labor Code,' you must forthwith
comply with such provisions or this permit shall be deemed revoked.
- -
S"
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
FINAL,DATE -
.
Issued by:
•
Validated by:
- INSPECTOR
9 ;tet 9,a
,iify
Date 12 Permit
This is a building permit when properly filled out, signed and validated, and is sublecl to
expiration if work thereunder is suspended for 180 days.
I certthat I have read this application and stale that the -above information is correct.
I agree to comply with all city and county ordinances grid 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 / T • 'i
Mailing Address 1 r .
Validation:
A7122
1' 15 , 64.52 U
City, State, Zip
`
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FFES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. Q. FT.
WALL SO. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKI_R SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM, B.T.U.
TEMP USE PERMIT SVC
\i ^
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
INAL INSP.
1
ROOFING
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
ROUND PLUMBIN Q
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 APP./EQUIP.
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. `� a a - &
FRAMING �-�-- �-�
INAL INSP.
1
ROOFING
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING-3�� 0 7
MESH
INSULATIONISOUND 2j (/I'
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL :d
• Desert Sands Unified School District
CERTIFICATION OF PAYMENT
` OF
SCHOOL FACILITY FEES
TO: City of La Quinta DATE:f /�Z*
Department of Community Development
78-105 Calle Estado'
La Quinta, CA 92253
This is to certify that
developer of ` which is I
located at -7,Q 1 1-62 within
this District, has paid school facili y fees imposed pursuant to the
authority generated by G vernment Cod S tioit,53080 in the amount of
covering a total of /G+p re feet of ( residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
for DESERT SANDS UNIFIED SCHOOL DIST ICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
4 6,Ce-?,a. i r �, a
( 10)-37