14899 (RER)44
P.O. BOX 1504 No. 14899
Building 53«9 Ave.78-495 CALLE TAMPICO
AddressNavarro LA QUINTA, CALIFORNIA 92253
'AA `""`'s"�' BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 2102 Broadmoor moor Ar.
A.P. Number
City Zip Tel. n
Palm..Spri;< g s o 92262 324--0501 Legal Description
Contractor Fisc d ;age samo�ipaI
-i
'0c'i o6d Cohstruction Project Description
Address
P.O. Box 126
P tyim fSpri ngs, :Rp 92263 Tel 92263
State Lic.City
& Classif.. B-528864 Lic. # Sq. Ft. No. No. Dw.
Size - - Stones Units
Arch.,' Engr.,
Designer New ❑ Add.❑ Alter ❑ Repair ❑ Demolition❑
Address
Tel.
�i
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
;l hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
ness a
7000) of Division 3 of the Busind Professions Code, and my license is in full force and
„'jetfect:-^r^" �, iy lvr n.Ji j',�r 3
SIGNATURE i DATE
OWNEW13UILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
Estimated Valuation @ e l� IItt
$12,,.000.00!pY
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
.' PERMIT , '• AMOUNT
permit to construct, after, Improve, demolish, or repair any structure, prior to .its issuance also
requires the applicant for such permit to Ile a signed statement that he is licensed pursuant to
the provisions of the Contractors 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 penally of not more than rive 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.) ..
Plan Chk.* Dep. -
Plan Chk. Bal.
Const. 135.00
Mech. -
Electrical
Plumbing
❑ 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 appty to an owner of propertywhobuilds or Improves thereon, and who contracts for
S.M.I, -
such pro)ects wifA a contractors) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. & P.C. for this reason
Grading
Driveway Enc.
Date owner
Infrastrlicture
WORKERS' COMPENSATION DECLARATION*
" I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
h
Worker's Compensation Insurance, or a certified copy thereof. (Sec: 3800, Labor Code.)
Policy No - Company
CJ0Pdpy is filed with the city. ❑ Certified copy is hereby furnished. ' r
'
TOTAL 135.00
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS'
(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
' Date � Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
suNect to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this Permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center '
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, ANDSjde
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
Rear Setback from Rear P ine '
Street Setback ff� CenLine
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
j/
Side Setback from P HDerty Lj
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND'
ATTORNEY'S FEES.
This is a building
g permit when properly filled out, signed and validated; and is subject to
expiration if work thereunder is suspended for 180 days.
FINAL DATE INSP R V
n
VQ
I certity that I have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state laws, relating to building
construction, and herebyauthorize representatives -of •this. city to enter the above-.
mentioned property for inspection purposes.
Issued by: Date rmit %
/
J(
Validated by:
Signature of applicant - Date
Mailing Address
Validation:
L:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW%3 FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. p
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. S0. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/4c
HOUSE SEWER
GRADING
cu. yd.
$ -Plus-X$-=$
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 APP./EOUIP.
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
�V
FIRE ZONE ROOFING
FIREPLACE.-
IREPLACESPARK
SPARK-ARRESTOR
ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
CCNDIT OVALLY
ACCEPTED FOR CC!t,STRUCTICN
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
/ /
DATE// i�-- B e oN
SCALE: � / " APPROVED BY: DRAWN BY
DATE: A �L L- REVISED
74 4::�,-4 ,
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DRAWING NUMBER
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1-1121 1"
7e2VI 7ZEZ;�
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
CCNDIT OVALLY
ACCEPTED FOR CC!t,STRUCTICN
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
/ /
DATE// i�-- B e oN
SCALE: � / " APPROVED BY: DRAWN BY
DATE: A �L L- REVISED
74 4::�,-4 ,
q
DRAWING NUMBER
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