002824 (BLCK)44
P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 52x'395 hiemW.a Juatw LA QUINTA, CALIFORNIA 92253
Owner
Iria D.
Mailing,
Address
City Zip Tel.
... .
Contractor
. 4 Jam' M .
Address
City
State Lic.
& Classif.
-Arch:, Engr.'
Designer
Address
BUILDING: TYPE CONST
A.P. Number
Legal Description
Project Description
Q0282
L;Ity
Lic. # Sq. Ft- .129 � No. No. Dw.
Size Stories Units
Tel.
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
2 -foot 1
City Zip State
L•ic. #
_ LICENSED CONTRACTOR'S DECLARATION
IIhhereby.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
hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. .703 1. 5, Business and Professions Code: Any city or county -which requires a
permit to construct, alter, impr6e, 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 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_lo 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
Estimated Valuation
'
-
PERMIT
Plan Chk. Dep.
Plan Chk.. Bal.
Const.
Mech.
Electrical
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
❑ I, as owner of the property, ani 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 -
._ .
S.M.I.
such projects wither contractor(s) licensed pursuant to the Contractor's License Law.)
.❑ I am exempt under.Sec. B. & P.C.- for this reason
Grading
Driveway Enc.
1.�Date' —i 7 Ownerll!- f�• + f) et•rl-•r c
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
!< i744
❑ 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 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. kk1 ,,• •� 7 f
Date Owner/ �, fill :.q. ,
\ 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
HARD COPY
TOTAL
q hall
935.00
AMOUNT-,
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
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST 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.
I 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FOUND. REINF.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SO. FT. ® c
BATH TUB
�'J
i�
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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 a
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
/
i
1 RE NF. STEEL 2
GAS (FINAL)
TEMP. POLE
G OUT
WATER HEATER
SERVICE
FINAL INSP.
�'J
i�
BEAM
- AVGRADING
WATER SYSTEM
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL.INSP.
FRAMING
FINAL INSP.
ROOFING
`
p� %
107111;- � .l
t'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
0
\s
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Pr;
pe 44
Ar4AH— 62) Ver -T,
CITY OF LA QUINTA
Community Dev el o P m enVBldg. Dept.
--y
PER
AND Ad AWUCABLL CODES
DATE y
By