07307 (RPL)TAi!t
P.O. BOX 1504 No. 0730.7 ,I
Building 54=511 Southern Hills 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner�l anal r
a
'
BUILDING: TYPE CONST. OCC': GRP
Mailing: a
Address 54-x511. $oUtheM, Hil , . ,.. A.P. Number P. I•,�.
City.. JZip ITO.,, �•
La Quinta .92253- 360 °7,021 Legal Description ,
Contractor Project Description P601
Cal iforn#a Pool 9SPas
' Addres
41 '910 gaaili r it k
city. Pala Dwarf ZIP. 92260 Tel.=.340—.90-00
State Lic. C-53 '.f 851102 City,
#
_355--,
Sq. Ft. No. ' No. Dw.
Size Stories -Units.,
Arch.; Engr., , "
Designer ? New ❑ Add ❑ • Alter ❑ . Repair ❑ ' Demolition'❑
Address Tel. ;
City Zip , State
Lic. #
t
} e LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that I am'licensed under promsion'spt. Chap
ter (commencit)g with Section
7000) W.Division.3lof the Business and Prof essio s Code and my license,is mADll force and
• • effect: d i + f ✓ � �
SIGNATURE- r I DATE -
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following Estimated Valuation' 13
q
reason: (Sec- 7031.5.8usiness and Professions. Code: Any city or county which requires a
Pemrit to construct,' alter,.improve; demolish, or repair any structure, prior to its issuance also
require& the applicant for Such permit to ill a signed statement that -he is licensed pursuant to PERMIT AMOUNT - '•:�.
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 703 1. 5 by -any applicant for a permit Plan Chk. Dep. .
subjects the applicant to a cwfl 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 Plan Chk. Bal. 4! •
45
do the work; and the structure isnot intended or offered for sale. (Sec. 7044, Bpisness and C'iorlSt: i�3
Professions Code: The Contractor's License Law does not apply to an owner of property who •
builds or inproves thereon and whodoes such work.himself or through 'his own employees, Mech.' a• `�'{�
provided that` such improvements are - not intended or offered for sale. If, however, the building ,
orIimprovement is sold within one year of completion, the owner-buider will have the burden Electrical +�
of proving that he did not build. or bnprove for the purpose of sale.) g •
O I, as owner of the property; aim exclusively contracting with licensed contractors to con- Plumbing 27.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License' Law .. •�
does not apply to an owner of property who braids or improves thereon, and who contracts for S.M.I. - -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
0 lam exempt, under Sec.' B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure 5
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.) `
Po icy No�Y760i(11-1. �mpany� ' ��:; 4--
�., svt
U,Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL • 1` `✓I- fir%'•
- CERTIFICATEOFEXEMPTIONFROM' REMARKS
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed it the permit is for one hundred dollars $100 valuation
or less.) - .
I certify that in the performance of thS work for which this permit is issued, I shall not 5
employ any person in any manner so as to become subject to the Workers' Compensation -
Laws of California t -
Date Owner
NOTICE TO APPLICANT: d, after. making this Certificate of Exemption you should become ZONE: BY: '
'subjectto the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such Proviwo_nsorthis Permit shall bedeemed revoked - Minimum Setback Distances:
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, CIO Code.) Side Setback from Property Line.
Lenders Name
Lenders Address FINAL DATE �' Q IN C R
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 1 have read this application and state that the above information is; correct. Issued by: L Date Permit''
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•. c7
mentioned property for inspection purposes. Validated by:
Signature of applicant Date t
Mailing Address Validation: r
City,_ State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
LUMBER GR.
FINAL INSP.
URINAL
SQ. FT. @
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
ISEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
CERT. OCC.
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 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.j^ /
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUOESIINITIALS
GARDEN WALL FINAL