9638 (BLCK)r
4,4
P.O. BOX 1504 No.
Building 78-105 CALLE ESTADO
Address 52-060 Vallejo LA QUINTA, CALIFORNIA 92253
Owner --7] ~
„_.Daniel g��il BUILDING TYPE CONrST. OCC: GRP.
Address 3r'2 -.me
City Zip Tel.
La Quinta -92253 564-5919
Contractor
Owner /Builder
Address
City' lZip I Tel.:
State Lica I City
& Classif. Lic. #
Arcn., tngr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION '
1 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. T�
.SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bustness and Professions Code: Any city or county which requires a
permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit. to, rile 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
sub ects the applicant to a civil penalty o/ not more than rive hundred dollars.($500).
I, as owner of the property, or my employees with wages as their sole compensation, will
o the work, and the structure is not intended or offered for sale. (Sec. 7044, Sufsness 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.)
❑ 'l, 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 1 B && P:C. for, this reason
Date Own`e.
WORKERS' COMPENSATION DECLARATION ' S
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... i
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not -be completed IfJth`'e"peAftVs for one hundred dollars ($100) valuation
or less.) .f 1 .� ,
I certify that in the performance of the work°for which_this.permit is issued, I shall not
employ any pperson in any mannei=so as to become subjedt<to the Workers' Compensation
Laws of Calif0 a. e .
' Date Owner -."..
NOTICE TO APPLICANT: If er making this Certfidcate 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 bb deemed revoked. ,
u ., F
CONSTRUCTION LENDING AGENCY r
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.) F .
Lender's Name
Lenders Address 1
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.
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-.
'l mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
A.P. Number
Legal Description
Project Description
35' of 44 plaster/stucco Nall
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ . Repair ❑ Demolition ❑
r
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:
M
Estimated Valuation
239.05
PERMIT
-AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
30.00
Mech.
Electrical
Plumbing
S.M.I.
Grading ,
Driveway Enc.
Infrastructure
TOTAL
30.00
-
REMARKS
r
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:
M
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
FOR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SQ 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
FINAL INSP.
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® V4c
HOUSE SEWER
LATHING
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
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.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINTTIALS
GARDEN WALL FINAL