001701 (AR)J
•
tyl
P.O. BOX 1504 N o . 0 017 01
Building 78-105 CALLE ESTADO
Address 53.-075 WIG Palam LA QUINTA, CALIFORNIA 92253
Owner
P.i'TEn� BUILDING: TYPE CONST. - OCC: GRP.
Mailing
Address A.P. Number
f'i .m>':flih i cin. �Ra.toc•..�..r--s.a
Tel.
-TA fhs Tro-P 4929;14 Legal Description
Contractor Project Description a Az4$�t3
Address
Sam
City Zip . Tel_
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr.,
Size r3." Stories Units* 1
Designer New ❑ Add ❑X Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State Pmmit fb. syMition.to rsw amstruftim
_ Lic. # ..
LICENSED OONTRACTOR'S DECLARATION ; ' of 's 16— familv &a1lim already in
,. 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' �C3�
effect
(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 of Exemption you should become
subject to the Workers' Compensation provisions of the Laboi 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 it 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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant / Date—
Mailing A i ddress
ateMailingAddress
City, State, Zip
HARD COPY
ZONE:
'
Minimum Setback Distances:
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
Rear Setback from Rear Prop._ Line
hereby affirm that I am exempt from the Contractor's. License Law for the following.-,
Any
Side Street Setback from Center Line
reason: .(Sec. 7031.5,Business and Professions Code: pity.or county which ,requires a'
permit to constiuct, after, improve, demolish, or repair any structure,prior to its issuance also
- -
FINAL DATE
,, requires the applicant for such.permit to file a signed.statementthat he is licensed pursuant to
.PERMIT "•' *'••
AMOUNT
s 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 civil penalty of not more than five'hundred dollars ($500).
Plan Chk. Bal..
40.62
O,l, 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
Const.
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,
'Meeh. -
provided that such improvements are not intended or offered for sale. If; however, the building
or improvement. is sold within one year of completion, the owner -builder will have the burden
Electrical
of 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
struct the project. (Sec. 7044, Business and Professions. Coda., -The Contractor's License Law
does not apply to an owner of property who builds or.improvesthereon, and who contracts for
S.W.
>
• 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.
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. O Certified copy is hereby..furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
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 of Exemption you should become
subject to the Workers' Compensation provisions of the Laboi 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 it 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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant / Date—
Mailing A i ddress
ateMailingAddress
City, State, Zip
HARD COPY
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:
A31%5
11 13 Z1 5,63 _CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. Ff.
WALL SQ. FT.
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
I ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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 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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I NSU LATION/SO U N D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
1 e
_
��F:IEp
. , ! o
-
eeert ands
Unied Scbol _' Dietrie$
- ,¢y .BERMUDA DUNES r
RANCHO MIRAGE
-• .- '• •^ -
`82-879 HIGHWAY 114 4..INDIO;:CALIFORNIA.92201-567810 (619) 347=8631
r INDIAN WELL'S;..y .
PALM DE.SERT,,,b
y8 95
,P LA-QUINTA
t
Ci ty rof La'` Qui nta..
Department o Community
Development .,
78=105•. Coal lb,Estado
La. Quinta, CA '9225:3
Re : 51.0'75- Ca'l�l:e Pa-loma
Ge,nt1 emen
The develope.r.,of the
above referenced lot:'
has mj:tigated its}impacts
on our overcrtotv�de:d schlool,s 5by payment
of the amouna of :$628`..per
uni t fto be ;applied to: the cost of
district educational
.facil"i;made-necessary`6y sucfi`new
de ve l o pme n°t
,
Since:rel'y: .
John.: Brooks
Ass -is -taut .'Super ntendent
-.
<Business Services
JDB,/crm
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t
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