003659 (RPL)P.O. BOX 1504 No. 003659
Building 78-105 CALLE ESTADO
Address' 7R -3 -ISI irl 1 p Xnf+� A LA QUINTA, CALIFORNIA 92253
Owner -
TrArtBUILDING: TYPE CONST: OCC: GRP.
Mailing
Address 78-118 Callas Norte •A.P.,Number D=aa Lc. Ouinta
City Zip Tel.
La Quinta, 92253 Legal Description
Contractor Project Description Spa
Patrick Z. Penlev
Address .•_.. .
�^2
City Zip Tela._ .
Palm Desert 92261 346-1469
State Lic. City
& Classif..C�,3�"�,1�3J�� Lic. # s- �,� Sq. Ft. No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑'
Address Tel.
City Zip State
Lic. # '
LICENSED CONTRACgTOR'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,Business 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, 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 thealleged exemption. Any violation of Section 7031.5. by any applicantfor a. permit
subjects the applicant to a civil penalty of'not more than five hundred dollars ($500).
O 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 o/ sale.) , .-
0 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.),
❑ I am exempt under Sec. B. & P.C. for this reason
stimated Valuati
M PERMIT
V�
Plan'.Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Date Owner ,Infrastructure
WORKERS' COMPENSATION DECLARATION
Thereby 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 i/ 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
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 it work thereunder is suspended for 180 days. '
I certify 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 hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
1®
1®
REMARKS
AMOUNT
Atli- 62
F2_5O
t
'f 1 n
1A 00
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:
YI
HARD COP _ ..
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 `IALUATION $
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
&OUGH PLUMB. — 7—
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
GAS (ROUGH) _
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.
SQ. FT. ®c
BATH TUB
BOND BEAM
SQ. 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
INAL INSP. !
ROOFING
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
&OUGH PLUMB. — 7—
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
OUGH WIRING d
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH) _
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
INAL INSP._ j
FRAMING
INAL INSP. !
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL