9875 (BLCK)Building
Address u
78520 Tujn S '.a
Owner
A 6 M Builder
Mailing
Address P. 0. Box 366
City Zip
La Quinta 92253
Same
Address.
7&105 CALLE ESTADO C NOX 1504
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. - OCC: GRP.
A.P. Number
Tel.
564-4832 Legal Description
State Lic. • I City
& Classif. 487584 Lic. # 626
Arch., Engr.,
Designer
Address Tel.
Cityj Zip State
i Lic. #
1 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm th't 1 alicensed under provisions of Chapter 9 (commencing with Section .
7000) of Division 3o'am licensed
the Business and Professions Codei and my license is in full force and
effect. • 11/1
Project Description
140 of 61 sltiT p stone Fall
Sq. Ft. No. No. Dw.
Size Stories Units .
New ❑ Add ❑' Alter ❑ Repair ❑- -Demolition ❑
'=A :; l; ,;,•,- OWNER -BUILDER DECLARATION
he
I reby,affirm that 1 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 -
k permit to construct, atter, 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 licensedpursuantto
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 theretiom, and the basis
'for the alleged 'exemption. Any violation of Section 7031.5 by 'any applicant /or a'permit -
Estimated Valuation
-`
3500.00 -
. ,
r PERMIT .'
-
AMOUNT
^Plan Chk: Dep.
• subjects the applicant to a civil penalty of more than five hundred dollars ($500). 1 . I .
O I, as owner of the.property, or my employees with wages as their sole compensationi`will _ .
2
!'.'Plan Chk. Bal.
Side Street Setback from Center Line
Const.
t� nA
6J , ypy
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
, Mech.
INSPECTOR
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. It, however; the building
Electrical
'
-
or Improvement is sold within one-year of completion, the owner -builder. will '.have the burden '
of proving that he did not build or improve for the purpose of sale.) .
Plumbing
Validation:
❑ I, as owner of the property, am exclusively contracting with licensed contractors to corr.
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.i. -
.40
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. 8 P.C. for this reason
Grading
-
Driveway Enc.
.,
+
Date Owner 7
s
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have acertificate of consent to self-insgre, or a certificate of
Worker's Compensation insurance, ora certified�opyrthereof. (Sec. 3800• Labor Code.)
Policy{�o. Company—�
O'Copy is filed with the city. ' I] Certified copy is hereby.furnished..
I
TOTAL
63.40
TIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURAN
(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 prson in any manner so as to become subject to the Workers' Compensation
Laws of Cal ifeni
ora.
REMARKS�(S6�
�(S6 7
_Gil. 812. J0 s.}riP
AV L49,.,►i 9 A 1 Ai 1
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of -Exemption youshould become
subject to the Workers' Compensationprovisions- of the Labor Code, . you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY .
Thereby affirm that there is a construction lending agency for, the'performance of the
work for which this permit is issued. (Sec. 3097, Civil Code*)
Lenders 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
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
$
i UNITS
A.C. UNIT
1ST FL. SO. FT. ®
SLAB GRADE
2ND FL. S0. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.'®
DRINKING FOUNTAIN.
SO FT ®
METER LOOP
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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
JAMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
REMARKS:
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
FIREPLACE
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. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM 2�
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFINGFt90
�t! J �
C�
i
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q
REMARKS:
VENTILATION
FIRE ZONE ROOFING: '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION- Az tot
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUF;ESIINITIALS
GARDEN WALL FINAL