10811 (MISC)TW*
�.
4P.14
O.4 / N o . 10811
Building.52-65a 9EL�SC4 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing C: •'�
®HN BETH MONTENEGRO BUILDING: TYPE CONST: �J OCGRP,
Address SAME
A.P. Number
City Zip Tel.
LA. Q.UINTA $2253. 564-4160 Legal Description
Contractor -"INSTALL GAS LINE' 100 •
OWNER BUILDER Project Description
Address ..
SAME
City Zip Tel.:
State Lic. City
& Classif. Lic. # �, Sq. Ft. No. No. Dw.
Arch., Engr.,
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ "Demolition ❑
Address I Tel,
City I Zip 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 I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any cHY or county which requires a
permit to construct, atter, improve; demolish, -or repair any-stnrchue, prior to its issuance also
requires the applicant for such permit to Me a signed statement that hes 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. the alleged exemption. Any •violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more,:fhan five hundred do0ars.(f500).
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 appy 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. lf, however, the building
or improvement is sold within one year. of completion, the .owner-buWar will have the burden .
of proving that he did not build.or improve for. the purpose of sale.) '
❑ 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 purrsluant to the Contractor's License -Law:)
O 1 am exempt under Sec. /B. & P.C. for this reason
(3-2Owner ?a^ f .rI.1j1 j;( ;'t t� r'
WORKERS' COMPENSATION DECLARATION y
I hereby affirm that I have a'certificate'of consenf'to self -insure, or a certificate of
Wrke
or s.Compensation Insurance, or.a.certified copy thereof -(Sec. 3800,. Labor- Code.).
Policy No. Company i s
❑ 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 performance of thg work for which this permit is issued, I shall not
employ any PPerson in any manner so as to become subject to the Workers' Compensation
Laws of California.
r• J' t
fj0ate =/' �!% Owner .'` ~ / '" i � J' , r " ; r • -jr.....I, c L, ,, ,_-"".,.
NOTICE TO APPLICANT: If, after making this Certificate of Exemptionyou should become
subject- tb the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this pemdt 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
l_
ZONE: BY:
Minimum Setback Distances- '
Front. Setback from Center Line
y 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:
Estimated Valuation
$150
PERMIT
AMOUNT
.Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
$30.00
S.M.I. .
Grading
Driveway Enc.
Infrastructure
TOTAL
§.10.00
REMARKS
ZONE: BY:
Minimum Setback Distances- '
Front. Setback from Center Line
y 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
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT. ®
GAS (ROUGH) y d
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
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.COQL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
r
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% c
SEWAGE DISPOSAL
SO.FT.GAR ® V.c
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 N
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
F
'FOUND. REINF.
GAS (ROUGH) y d
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 x$
-$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -4<
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL