10785 (PLBG)P.O. BOX 1504
Building -464 Ave.care LA QUINTA8-105 C
Address CALIFORNIA 92253
Owner
Mr/sirs Jeffrey Somers
Mailing
Address same
City Zip Tel.
La Quinta 92253
Contractor
L. L. X.iis6n Construction
Address
P. 0. Boys 1687
CitIndio 1Zip9220I Tel.: 342-2322
No. 10785
JILDING: TYPE CONST. OCC: GRP.
P. Number 774-071-011
Description_
;t Description
Serer Hook Up
State Lic.
City
& Classif. 529319
Lic. #
Sq. Ft.
No. No. Dw.
Arch., Engr.,
Size •
Stories Units
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition p
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
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. � 1 %' j lbw 3 i/'S w
_SIGNATURE -"' ? "' '-'-' DATE
'
OWNEWBUILbER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
3 E34
- reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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
PERMIT
AMOUNT
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 Section 7031.5 by 'any for
Plan Chk. Dep.
of applicant a permit
subjects the applicant to a crw7 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
Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Suisness and
Const.
Professions Code: The Contractors 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, '
• Mech. '
provided that'such brrprovements are .not intended or offered for sale. If, however, the budding
or improvement is sold within one year of completion, the owner -builder. will have the burden
EIBCtrICdl
of proving that he did not bund 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. '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. R. 8 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
30.00_ ,.
CERTIFICATE OF EXEMPTION FROM '
REMARKS
�'t:� x' i:I.�Y. �t 7-;: r �fi. "-'` ^ •' : " �:tiVvk
WORKERS' COMPENSATION INSURANCE
(Thfs section need not be completed ff 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 malft this Certificate of Exemption you should become
subject to the Workers' Compensation provisionsis of the Labor Code, you must forthwith
comply with such provisions or this pemrit shat 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
LendePs Address
- This is a building permit when property 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 of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
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
r -
Issued'by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® =
2ND FL. SO. FT.
POR: SO. FT. ®
GAR. SQ. 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
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 APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
IKITCHEN 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
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
C�
SO.FT.GAR ® V4c
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE 7NST.
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 OR4fi0R@-_d LAKs/
OUGH 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
cu. yd.
$ -plus-x$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
C�
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIObI / jA2
�7 ,/`
CERT. OCC.
\FENCE FINAL
INSPECTOR'S SIGNATURESIINRIALS
GARDEN WALL FINAL