10383 (RER)Tav 4 sa Qu h -A
P O BOX 1504 _t i! No 10383
Building 53-700 AVENIDA CORTEZ78-105CALLEESTADO. -- e �J •
At1rIrASC LA QUINTA,.CALIFORNIA 92253 �
Owner ONIDIO E. CNAPA, JR.
Address SAFE
City Zip -Tel.
LA QUINTA 92253 564-5498
OWNER BUILDER
Address
SAME
IZip I TeL
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip I Ste
Lia #
LICENSED CONTRACTOR'S DECLARATION
I. hereby affirm that I am licensed under provisions of Chapter (commencing with Section
70(10) 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 Law for the following
reason: (Sec. 7031.5;Bushess and. Professions Code: Any city or county which requbes a
permit to construct, alter, improve, demofish, or repair any structure._ prior to Its issuance also
requires the applicant for such permit to No a signed statement that he Is licensed pursuant to
the, provisions of the Cordrectors Lkense 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
jub
,ts.the applicant to a civil penalty of rat more than 8ve hundred dollars (E500).
1, as owner of the. property, or my employees with wages as their sole compensation, will
db the work, andahs structure Is not.intended,or offered for sale. (Sec. 7044, Bulsness and
Professions Code: The Contractor's License Law does not apply to anownerof property'who
-
builds or Disproves thereon and who does such work himself or through his own employees,
provided that such Improvements are not intended or offered for sale., h, however, .the building
or Improvement is sold wtlhD) one year of completion, the owner -builder will have the .burden
of proving that he did not build or Inprovefor the purpose of sale.)
0 1, as owner of the; property, am exclusively contracting withlicensedcontractors to con-
struct the project: (Sec. 7044, Businesss-and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds ofimproves Itherson, and who contracts for
such projects with a contractor(s)licensed pursuant to the Contractor's License taw.)
❑ 1 am exempt under Sec. a, g P.C. for this reason
Data - �'b�er r s - 'r
WORKERS' -COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers 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 panne is for one .hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit Is Issued, 1 shall not
employ any person dn,any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT:, If, after mailing this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must foimwith
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, Clvs Code.)
Lender's Name
Lenders Address
This is a building permit when properly filled out; signed and validated, and is,aubject't0
expiration if work thereunder Is suspended for 180 days.
I certify that 1 have road this application and state that the above information is correct.
.I agree to comply with all city and countyordinances 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
BUILDING: TYPE CONST. OCC: GRP..
Number
Legal Description
Project Description MANUFACTURED FIREPLACE
INSTALLED
Sq. Ft. No. No. Dw.
Size Stories Units
New O Add ❑ Alter ❑ Repair ❑ Demolition ,❑
Estimated Valuation
$345.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. • 0
Mach.
Electrical
Plumbing
S.M.I._
Grading
Driveway Enc.
Infrastructure
TOTAL 430.00
REMARKS
• � r:_' ..: �'�"�."s..e •� �'I)iZ"1i i iFF tti�t
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR SO Ff ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. Ff.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. tib
OTHER APPJEOUIP.
DRINKING FOUNTAIN,
SO FL ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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,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. REBID ® t t6 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
HOUSE SEWER
MESH
GASiPIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
OONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 6 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. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
= plus xt
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFINGREMARKS`
�/�VENTILATION e
/ 2 � ! / A
�j ✓
c /�j �p
Fi!/ / "r/;?
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIOWSOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINRIALS
GARDEN WALL FINAL