11493 (AR)Building '!Y
Address, 52-655 VELASC6
Owner
JRRN CARRERA
Mailing
Address 52-655 VELASCO
City Zip
--LA QUINTA . 92253
Contractor
1.OWNER BUILDER
Address .
SAME
City' IZip
SKRE '
State Lic. ,
& Classif.
Arch:,. Engr.,
Designer
Address
P.O. BOX 1504 N o . 11493 , }
78-105 CALLE.ESTADO
LA QUINTA, CALIFORNIA'92253:
. I
564--7319 -
I Lic. #
el.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal .Description
Project Description ROOM ADDITION BEDROOM AND
BATH
Sq. Ft.No. No. Dw.
Size • 256 Stories . Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
City
Zip
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
Estimated Valuation r
I hereby affirm that I am exempt from.the Contractors License Law for the following
38i.80
reason: (Sec; 7031.5,13usiness and Professions Code: Any city or county which requires a
permittoconstruct, after, 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
.$13 s
PERMITAMOUNT-
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
- I
Division 30f the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the - Any Section 7031.5 by 'any fora
Plan Chk.`Dep. • '
alleged exemption. violation of. applicant permit
subjects the applicant to a civil penalty of not more than rive hundred dollars.($500).
,1I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. BBI. $99-45
• 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
'
Const. 15340
builds or,improves thereon and who does such work., himself or through his own employees.
Mech. l� 9 Q
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
Electrical • y 3 � 9
of proving that he did not build or improve for the purpose obsale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing 33.00
struct the project.- (Sec. 7044; Business andi,Professfons Code: The Contractor's License Law.
does not apply to an owner. of properly..4�h buililsror improves thereon, and who contracts for
S.M.I. - - .98
such projects with a contractor(s) licensed'b+uAt to the Contractor's License Law.)
TT
Grading
0 1 am exempt under Sec: ' �: /B. & P.C. for this reason
n t ,-.*' r--•`"
s Driveway Enc.
D
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.)
1 �:
Policy No. Company �r'r
• Copy is tiled with the city: ❑Certified copy is fieretiy furnished. r. .
'' /
' TOTAL $329.90
CERTIFICATE OF EXEMPTION FROM �~1i .
REMARKS.
WORKERS' COMPENSATION INSURANCE' .Yf
(This section need not be completed if the permit is for one hundred dollars ($,100), valuation
Y,�,` y t r J"y`'' ;r,, t
. ` �:{ {?'A•C123,1, j- ;(t ✓' }`r'yd
' or less.) - . ,• ,.'
•fes
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any peon in any'manner so as to become subject to the Workers' Compensation'
'
Laws of Californirsa. ^rrr
'
Date Owner rrF
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
ZONE: BY:
subject' to the Woikers' Compensation provisions of, the Labor ICode, you must forthwith
comply with such provisions or this permit shall be deemed revoked:'
Minimum Setback Distances: -
Front Setback from'.Center Line
Rear Setback from Rear. Prop: Line •
- CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
1 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.) -
Side Setback from Property Line
Lender's Name
I
Lender's Address
FINAL DATE INSPECTOR
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.
Issued by: Date Permit' -
I agree to comply with all city and county ordinances and state laws relating to building.
construction, and hereby authorize representatives of thisi city to enter the -above-.
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
'
Mailing Address
Validation:
City, State, Zip
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
CAR P. SO. FT. ®
GAS (ROUGH)
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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING [/ 4G
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, TEMIPERM
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 ® 1Yi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Yic
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK
00,
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
HEATINGIFINAL)
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 [/ 4G
FINAL INSP.
ROOFING �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRA
FINAL INSPECTIO
C CC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINTTIALS
GARDEN WALL FINAL