08046 (AR)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 49-000 ElAido LA QUINTA, CALIFORNIA 92253
Owner
Address
City TZip
Address
73-£12 HW 111, 37
City Zip
va1n► fla&gWr# G9
State Lic. I City
& Classif. 31IN34 Lic. # 203
Arch.;'Engr:,
Designer
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
70 OO) of Division,Wof the Business Professions Code, and my license is in full force and
effect. .t
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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
A. requires the applicant for such permit to rile 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 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 of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
O I, asowner 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 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 �'; "• -^�-^ '="` -�
0,Gopji 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 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.
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.
BUILDING: TYPE CONST. - OCC: GRP._
A.P. Number La Quinta CC Estates
Legal Description
Project Description RewAel A additinn
i � 4
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 5/29190 Permit
Validated by:
Validation:
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$93d2
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
76.05
Const.
117.00
Mech.
15.00
Electrical
15.00
Plumbing
S. M.I.
.70
Grading
Driveway Enc.
Infrastructure
TOTAL
$223.75
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 5/29190 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
4
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
t
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
HEATING (ROUGH)
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
ROUGH WIRING.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
CAR P. SO. FT. ®
METER LOOP
DRAINAGE PIPING
HEATING (FINAL)
WALL SQ. FT.
ri:
DRINKING FOUNTAIN.
TEMP. POLE
SO FT ®
URINAL
GROUT
ESTIMATED CONSTRUCTION VALUATION $
SERVICE
WATER PIPING
FINAL INSP.
NOTE: Not to be used as property tax valuation
BOND BEAM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ ` Plus—X$—=$
WATER SOFTENER
LUMBER GR.
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
ROOFING 7/3O
VENTILATION
APPLIANCE DRYER
GARBAGE DISPOSAL
REMARKS:
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING d-OWIV
BOILER. B.T.U.
SO. FT. @ c
BATH TUB
MESH
SQ. FT. ® c
WATER HEATER
INSULATION/SOUND ' 9
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
FINAL INSPECTIONL 6
GAS PIPING
P4-
4-PERMIT
PERMITFEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE rPL.CK.FHE
CONST. FEE ' ELECT. FEE
SMI FEE
PLUMB. FEE -.
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK �( 0
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE9
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. —4(' C
FRAMING 7/1 9®
FINAL INSP.
ROOFING 7/3O
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING d-OWIV
MESH
INSULATION/SOUND ' 9
FINISH GRADING
FINAL INSPECTIONL 6
CERT. OCC.
'FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL