14411 (GRES)P.O. BOX 1504
Building 441520 Verbena Dr. 78-495 CALLE TAMPICO
Address ' LA QUINTA, CALIFORNIA 92253
No. 14412
owner Mr `,y Caron ell
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Conversion
Project Description
Mailing '
- Address Samla
City
.La Qiiinta, C�
Zip
. 92253
Tel.
ContractorGarage
. Roger - Snelienberger & Associates
Address
55"695 Pebble Beach
Cja Qulnfa, CAI
Z'p92253
TeI'1177-7767
State Lic.
& Classif. $ 488234
City
Lic. # 185$
Sq. Ft. 224 No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑ Alter ❑ Repair ❑
Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am,licenseci under provisions of Chapter 9 (commencing with Section
7800) of Division) of thirBusiness andfPr'dfessions Code, and my license is -in fullforceafid�.
�frs feet. i l /W 7 1 l.f
'
SIGNATURE XDATE
OWNER -BUILDER DECLARATION
I 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
subjects the applicant to a civi penalty of not more than rive hundred dollars ($500).
01,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 contractor(s) (Icensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. & P.C. for this reason
Estimated Valuation $7,773.00
- PERMIT
.
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
64.335
C'iohst.
99 • 00
Mech.
15 N 00
Electrical
23.24
Plumbing
-
.00
S.M.I.
7.77
Grading
-
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereb affirm that I have a certificate of consent to self insure, or a certificate of
Worker's mpensatlon Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Pol c o. Company
Copy Is filed with the city: 0 Certified copy is hereby furnished. -
TOTAL
209.36
CERTIFICATE OF EXEMPTION FROM -
WORKERS' COMPENSATION INSURANCE -
REMARKS
'
(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 the 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.
ZONE: BY:
Minimum Setback Distances: -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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 ($1DD,000), IN ADDITION TO THE COST OF COMPENSATION,
Side Street Setback from Center Line
- Side Setback from Property Line
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 it work thereunder is suspended for 180 days.
FINAL DATE INSPECTOR
, -
�r
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.
Issued by: Dat Permit
Validated by:
Signature of applicant Date
Mailing Address
Validation: --r'
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
B NDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPI;JG
CAR P. SO. FT.
OTHER APPJEOUIP.
REINF. STEEL
WALL SO. Ff.
TEMP. POLE
DRINKING FOUNTAIN.
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
i
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYST
FLOOR DRAIN
MECHANICAL FEES
_$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
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, TEM/PERM
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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
UN RGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. .
B NDING
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
WATER SYST
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FIN/INSP.
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 SIGNATURESIINITIALS
GARDEN WALL FINAL