003756 (RPL)Building
Address
P.O. BOX 1504 N Q ; � �
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing - - - - - BUILDING: TYPE CONST. OCG: GRP:
Address 54-353 Ave. Velas o_ A.P. Number 774•-251-017
City Zip _ Tel.
i-$.. Mint 92253 554-1689 Legal Description
Contractor Project'&scription Pool
Address
Tel. -
92234 323-7303
City
Lic. # 355Sq. Ft. No. No. Dw.
Size Stories -Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel. _
f
... j
State-
Lic. # 9236
rRACT.OR'S,DEC LARATION
Drovisions'of Chapter 9 (commencing with Section 1
rofessi�ris Code, and my license is in fulLforcie,add� "
City -. I
Cat City
State Lic.
& Classif. 18512
Arch., Engr.,
. Designer
William
Address
lst;7_ n W CAtr+f* -Ala
City
.w�•-•+---•i•_-- LICENSED
I hereby affirm that I am licensed
7000) of Division 3 of the Business
effect. .1 .. ..p >_---
SIGNATURE - \ .C+ 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, 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
the provisions of the Contractor's Licnse Law, Chapter'9 (commencing with Section .7000) or
' Division' 3 of the Business 'and Professions Code, oi. that. he is exempt' therefrom, and the basts
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 than -five hundred dollars ($500).' '
❑ 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 dtd 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 pursuant to the Contractor's License Law.) •. .
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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
O 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 tha 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.
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
HARD COPY
REMARKS
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-ZONE:
BY:
stimated Valuation .61:80 .
PERMIT
'AMOUNT.
Plan Chk. Dep...
Plan Chk. Bal.
Const.'9_
.
Mech.
INSPECTOR
Electrical
1i
Plumbing
I.A IM
S.M.I.
Validation:
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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-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
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
ti
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax va°uation
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
'
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROCK STORAGE
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
WATER SYSTEM
SO.FT.GAR ® 3/ac
HOUSE SEWER
$
GRADING
cu. yd.
plus x$
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
14mDERGROUND Y`/
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 APPJEQUIP.
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
00
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