12496 (PLBG)V
._ `
' - P.O. BOX 1504 ° No12496 '
Building 78-105 CALLE ESTADO
Address 78--560 Niiestxa LA QUINTA, CALIFORNIA 92253 4
i
Owner
Francisco & Esther Y*10reno
BUILDING: TYPE CONST. OCC: GRP.
Mailing -
Address P.C). Box, x#76
A.P. Number
CityZip Tel. +
La Quinta, CA 92253 _ I . 564--4526 Legal:Description
It Contractor
Owner/Builder
Address
City Zip
State Lic.
& Classif.
Arch., Engr., -
Designer
Address
Project Description 35" of gas 1 Lnie
Tel.:
Lic #
Tel.
f
. Ft.' No.
e - Stories
w ❑ Add ❑ Alter ❑
No. Dw.
Units
Demolition ❑
Repair ❑
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 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 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
fon a ack Tom Center Llne—
Rear Setback from Rear Prop. Line
Side S'freet Setback from Center Line
Side Setback from Too Line
City
Zip
State
Issued by:
Lic. #
t' LICENSED CONTRACTOR'S DECLARATION
Validated by:
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. •
r
Validation:
SIGNATURE DATE
.. _
OWNER -BUILDER DECLARATION i
I hereby that I from the Contractor's License Law for the following
Estimated! Valuation ¢ ��yy A/�
150 00
affirm am exempt
` reason: (Sec. 7031.5, Business -and Professions Code: Any city orjjcounty which requires a
t permit to construct, alter, improve, demolish, or repair any structure, iprior to its issuance also
+}
i requires the applicant for such.permit to rile a signed statement that he is licensed pursuant to
PERMITAMOUNT
the provisions o1 the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
�
Division 3 of the. Business and Professions Code, or that. he is exempt therefrom, and the basis
for the Any Section 7031.5 'any for
- - - - -
Plan Chk. Dep. - -
alleged exemption. violation of by applicant a permit
" subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
,
Plan Chk. Bal.
' ❑.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
Const.
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,
Mech. -
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year or completion, the owner -builder will have the burden
Electrical -
of proving that he did not build or improve for the purpose or sale.)
❑ I, as' owner of the property, am'exclusively contracting with licensed contractors toc.
Plumbing
300.0
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. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ...
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Y
sye`e Owner >'jf+.r1�, r �rY`t:�i:`RG;72.�•
•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.
n ;
TOTAL
CERTIFICATE OF EXEMPTION FROM •
REMARKS
f
WORKERS' COMPENSATION INSURANCE
:i
(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 thg work for which this permit is issued, I shall not
'
employ anypperson in any manner so as to become subject to the Workers' Compensation
?
Laws of Califo'rnia,.,
'
>,Owner
D?to
,NICE 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
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
F t S tb f
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 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 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
fon a ack Tom Center Llne—
Rear Setback from Rear Prop. Line
Side S'freet Setback from Center Line
Side Setback from Too Line
FINAL DATE
SPECTOR
Issued by:
'Da I\Ifl1! nPermltQI
�.
-
Validated by:
.
B
r
Validation:
a
�t
CONSTRUCTION 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. SO. FT. ®
I POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO. FT. ®
OTHER APPJEOUIP.
REINF. STEELGAS
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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 APPJEOUIP.
REINF. STEELGAS
(FINAL J
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP. 5'�/9%
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL