13107 (PAT)Ct/
? P.O. BOX 1504
Building 78-795 Sanita 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Al Voegriy
Mailing
Address Sate
City Zip Tel.
La Quinta, CA 92253
Contractor
Ron Noriin Construction
Address
41-620 Ste Anns Bay Drive
City Zip Tela
Buda Dunes, CA 92201 360-'2023
State Lic. City
&Classif. 2561$4-A Lic.# 194
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
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.
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,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 or 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 or 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
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 or sale.)
❑ 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 or 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 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
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
WORKERS' COMPENSATION INSURANCE
(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 thg 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 or 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
No. 13107
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description Satin cover
Sq. Ft.
Size j
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
IJ
Const.
Mech.
Electrical
Plumbing
S.M.I.
_ ?7
Grading
..
Driveway Enc.
Infrastructure
�1n
;_21 1V
I
TOTALQ
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 I NO. I ELECTRICAL FEES NO. I PLUMBING FEES
IST FL. SO. FT. (off $
UNITS
-
��
COLL. AREA
YARD SPKLR SYSTEM
2ND FL. i SO. FT.
BONDING
HEATING (ROUGH)
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF. !
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
''
FINAL INSP.
DRINKING FOUNTAIN,
WALL SO. FT. ®
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
URINAL
SQ. FT. @
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN I EVAP.COOL - HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE i DRYER
I
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRYTRAY
'AIR HANDLING UNIT 1 CFM
KITCHEN SINK
ABSORPTION SYSTEM I B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR ! HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM j FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER j B.T.U.
SO. FT: ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ., FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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 1 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK I
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
s
REMARKS:
VENTILATION I
I
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR }
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING f
FINAL INSPECTION lIlk
CERT. OCC.
FENCE FINAL 1
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL