15078 (RPL)TAt(P 01 .&Qru«tw
P.O. BOX 1504 No. 15078,
Building 78-495 CALLE TAMPICO
Address 78-745 Spyglass $111 LA QUINTA, CALIFORNIA 92253
Owner 14&-. & ltr8. Elli 1 y
��d
BUILDING: TYPE CONST. OCC: GRP. •
Mailing ' Same
Address
1. A.P. Number
CityZip
La Quin a, C
CERTIFICATE
.. 9225:3
Tel.
340-6225
Legal Description
Project Description
and Spa"
ContractorPool
Date Palm Ente prises
...Add ess•
91!670 AVe. 'Prirmvera
Cit Zip
Cit Citi CA 9223?
Tel.:
325 -2187
State Lic.��,� �g�77J
& Classif..
City
Lic. #
Sq. Ft.
Size
New ❑ Add ❑
No. No. Dw.
Stories Units
Alter ❑ Repair.❑ Demolition ❑
Arch., Engr.,
Designer
Address
Tel.
City
Zip
State
Lic. #
LICENSED -CONTRACTOR'S DECLARATION
I heretrvaffirm that I am licensed under provisions of Chapter 9 (commencing wilh.Section
7000) of Oivissiilon 3 of4he Busihess/and Professions Code, and my license is in f Ijleforrce/add..
fi+p^t"""- A.�.�.'rf �.. �•,�^'�3'�. �,..«.�..r-�..._ .f �431'.lF.:l�
-
- -
Estimated Valuation
$14,000.00
t&IGNATMRE'" 7S 'DATE
OWNER -
I ..�� BUILOERDECLARATION
I hereby affirrh that I am exempt from the Contractors License Law for the following'
reason: (Sec. 7031.5,Bustness'and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, • prior to Its Issuance also
- requires the applicant for such permit!to-Ble a signed statement that he is 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 penally of not more than rive hundred dollars ($500).
0.1, as owner of the property, or my employees with wages as their sole, compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who'does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) -
❑ I. as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. -(Sec. 7044, Business and •Professions Code: The Contractor's License Law
does not apply to an, owner of property who builds or .improves thereon, and who contracts for
such projects with'a contraclor(s) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec B. & P.C. for this reason
- PERMIT
-
- AMOUNT
Plan Chk. Dep.
-
Plan Chk. Bal.
99.45
Const.
+�.
• 00
Mech.
27-4.60
ElectricalA
4 S. OR
Plumbing
O
S.M.I..
.
-
Grading
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy N Company
I o y Is filed with the city, ❑ Certified copy is hereby furnished.
k
TOTAL
Q$.45.
348.45-
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 m any manner so as to become subject to the Workers' Compensation
Laws of Califomfa
Date Owner
NOTICE TO APPLICANT., It, 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR 'CODE, INTEREST, AND .
ATTORNEY'S FEES.
This is a building permit when property 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
REMARKS
ZONE: BY:
.Minimum Setback Distances -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center //Li�ne
Side Setback from PropertyLine��\
FINAL DATE I
Issued by: Date_
Validated by:
G
0
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FL S
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
^
ROUGH PLUMB.sl6-C
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (ROUGH) �f�� y
G
METER LOOP
DRAINAGE PIPING
CAR P. SO. FT.
HEATING (FINAL)
OTHER APPJEOUIP.
WALL SO. FT.
GAS (FINAL)
DRINKING FOUNTAIN.
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
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
GRADING
cu. yd.
plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
ROOFING
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
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+A c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
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
NDERGROUNDr'�/ �J
A.C. UNIT
COLL. AREA
SLAB GRADE
^
ROUGH PLUMB.sl6-C
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
I ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) �f�� y
G
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INS 1 ` 7
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
AL INSP.
< /
ROOFING
C �� r Ae
—
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