10088 (RR)Buildin
Address 53°-085 Navarro
Owner
Sara De La Rosa
Address same
4
P.O. BOX 1504
78-105 CALLE ESTADO .
LA QUINTA, CALIFORNIA 92253
City I Zip Tel.
La.Quinta . 92253 564--2877.
Contractor
owner/Builder
Address
Zip Tel.:
State Lic. City
& Classif. I Lic. #
Arcn., tngr.,
Designer
Address Tel.
City izip I 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. .
SIGNATURE-- DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Lawfor the following
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 rile a signed statement that he is licensed pursuant to
the -provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Dlvisfom3 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
V
rjects the applicant to a civil penalty of not more than live hundred dollars(8500).
as o�6er of the property, or my employees with wages as their sole compensation, will
1 3 work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness.and
ofessidns Code: The Contractor's Ucense Law does not, apply to an. owner of property who
ilds,,//or improves thereon and who does such work himself or through his own employees,
ovlded 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.)
ill's owner of the property, am exclusively contracting with licensed contractors to con -
he pro
the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
d �as n . apply to an owner of property who builds or Improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
ppr r # ,p Y ,/
Date'-, f. 1)"! 3frf.;Owner } 1 tr . 1, I�i.4t till l ti• Avti%
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.
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 perforL6 of the work for which this permit is issued; I shall not
employ any person infany m nner; so as to become subject to the ,Workers' Compensation'
Laws of Cali orn .1 t t j 14�
Owner ' �t?e Ii f, , Lj
NOTICE TO APPLICANT: ,l , 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
Ihereby 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 slate laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for Inspection purposes.
Signature of applicant t Date
Mailing Address
City, State, Zip
No. 10088
(BUILDING: TYPE CONST: OCC: GRP, •
,A.P. Number
,Legal Description
Project Description
Re . Roo f
Y•
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
t
r'
Estimated Valuation
4,000
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
63.00
Mech.
Electrical
Plumbing
S.M.I..
Gradin
n
Driveway Enc.
Infrastructure
TOTAL
63.40
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:
CO TRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT. ®
BONDING
YARD SPKLR SYSTEM
POR. SQ, FT, ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. ®
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER HEATER
SERVICE
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR ® 3Yic
HOUSE SEWER
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 j of
✓
r
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION V
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL