003709 (AR)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 51-523 Juarez LA QUINTA, CALIFORNIA 92253
HARD
BUILDING: TYPE CONST. OCC: GRP.
Mailin 9
Address
A.P. Number
773.042-017
City
Zip
Tel.
- .
192253
Legal Description
Contractor
Project Description
Millieion a"A CtarA CTA_ ennVPT—skf.^n
.�
Address
P. £i• BL's 366 ..
City
Zip
Tel.
. Omit•
92253
564-4832
I
State Lic.
City
& Classif..
Lic. #.
Sq. Ft.
Size 380
No. No. Dw.
Stories Units
Designer -
New ❑ Add ❑
• Alter ❑• Repair ❑. Demolition ❑
f
Address
Tel.
{.._
City
Zip....
State
,y
Lic. #
I -
<. P
LICENSED CONTRACTOR'S•DECLARATION
I hereby affirm that I a0licensed under provisions of Chapter 9 (commencing with Section '+
7000) Division
r
of 3 of the=Business and Professions Code, and my license is in full force and
effect. . .� —r^e ^"' e r •ate
SIGNATURE / Ile ./ ../ - i �,7� /} DATE
• OWNER -BUILDER DECLARATION'
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
$100-000 f
reason: (sec. 7031.5,Business and Professions Code: Any city or county which requires -a
-
I
permit. to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
- •
-
requires the applicant for such•permh to rile a signed statement that he is* licensed pursuant to
PERMITAMOUNT
'
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
.r�
Division 3 of the Business and Professions Code, or that. he is exempt therefrom: and the basis'
for the exemption: Any Section 7031.5 by 'any for
Plan Chk.Dep.
- -
alleged violation of applicant a permit
' -subjects the applicant'to a civil penalty of not more than five hundred dollars ($500):'•
Plan Chk. Bal.
-
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
��Y2.•32 z -
$
do the work, and the structure is not intended or offered .for sale. (Sec. •7044, Buisness and
Professions Code., The Contractor's
Const.
••-
• License Law does not apply to an owner of propy who
builds or Improves thereon ert
eon and who does such work himself or through his own employees,Mech
s !i
provided that such improvements are not intended or offered for, sale. If, however, the building
.
I
or improvement is sold within one year of completion• the owner -builder will have the burden
EIQCtrICdl•
12.00
_ of proving that he did not build or improve for the purpose of sale.) - _
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
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.
•'r'-
- such projects with a contractors) licensed pursuant to the Contractor's License Law.)
.67
f
Grading
0I am exempt under Sec. B. 8- P.C. for this reason
(
Driveway Enc.
Date Owner
Infrastructure
I
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 Nd. Company
j
O Copy's filed with the city, ❑Certified copy is hereby furnished.
rt a tin t r+ a•<n •�•+ < •- + _
_
TOTAL
atr l;n.:�f r' yt i4',L-117 i^`3Ap-.1Yi � ` �
CERTIFICATE OF EXEMPTION FROM
REMARKS
i
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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, after making this Certifi•:ate of Exemption you should become
ZONE:
BY: t
' subject to the Workers' Compensation provisions 'of the Labor Code: you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: !
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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
s
FINAL DATE
INSPECTOR
This is a buildin g permit when properly filled out, signed and validated, and is subject to'
expiration if work thereunder is suspended for 180 days.
r
y J
3 11 /83
I certify that I have read this application and state that the above information is correct.
'
Issued by:
f
'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:
a
Signature of applicant Date
Mailing Address
Validation:
,
City, State, Zip
HARD
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING VE --S,
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT. ®'
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
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 ® 1+/a c
SEWAGE DISPOSAL
��
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION 6
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
-� Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
(UM
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253 NOTICE: THIS DOCUMENT CANNOT
This is to certify that ¢`
developer of , which is
located at �/- 7 // , within
this District, has paid g0hool fac' ity fees imposed purs-cant to the
authority- nera ed by Government Code Sec on 530 0 in amount of
$
covering a total of square feetqff ( 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•UNIFI D SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning 0 Pink - Accounting • Gold - Developer
(10)-37