11564 (AR)Building
Address 53-3.11 Jruarez
Owner
Mailing
Address
City Zip
Contractor
Address
State Lic.
& Classif.
Arch., Engr.,
Designer Robert C
Address
2350 ITynt� i. n A
City '. Zip
T4*
P.O. BOX 1504 No. 11564
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.'
Tel.:
City
Lic. #
Tel
(213't
State
Los Ancleies' 90039 Lic. #
A
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,Susiness 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 of the Contractor's License Law, Chapter9'(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.)
❑ 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 of 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. Be8rP.C. for this/eason ^�
Date ' e ! elOwner
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. 0 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 th0 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 ZONE: BY:
subject to the Workers' Compensation provisions 'of the Labor Code; you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. - - -
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
LDING: TYPE CONST. OCC: GRP.
P. Number
Legal Description Lot 3 of Block 1$2
Project Description Er-larcre master bedroom and
add roaster bath '
Sq. Ft. 395
Size
No. 1. No. Dw. I
Stories Units
New ❑ Add 9)
Alter ❑ Repair ❑
-Demolition ❑
Estimated Valuation
$10,?93.50
PERMIT
AMOUNT
Plan Chk-.'Dep. '
Plan Chk. Bal.
81.90
Const.
1.25.00
Mech.
21.00
Electrical
21183
Plumbing
33.00
S.M.I.
1.10
Grading
Driveway Enc.
Infrastructure
TOTAL
284.83
REMARKS
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.
1 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
Issued by: Date Permit
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. S0. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® Vic
HOUSE SEWER
FRAMING 10�
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE A_
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 [i 2[(
*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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING 10�
FINAL INSP.
ROOFING
VENTILATION
G�
a / 2
VL
/
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESHNITIALS
GARDEN WALL FINAL