09311 (PAT)Building
Address
Address same
City Zip
La Quintal92253
Contractor
Address
414a
`t At •
P.O. BOX 1504 V1( N o ; 0931-1.
78-105 CALLE ESTADO
gq�a LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Tel.
345.7433 Legal Description
Project Description
Zip I Tel.:
State Lic. City
& Classif. .1 1 Lic. #
Arcn., Lngr.,
Designer
Address Tel.
City Zip State
Lic.-#
LICENSED CONTRACTOR'S DECLARATbON
I hereby affirm that I am licensed under provisions of Chapter:9,(commencing with Section.
7000) of. Division 3 of -the -B and Profess ions -Code, ,and y`license is in full force and
effect 7 I _... e+ f� i -•iC' i
SIGNATUREI -+' / f• .'•:+� ;iY•,._. DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I 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
permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance also
repuires the applicant for such permit to file 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
+ _Ibr:•.the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
�:. subje_cls the applicant to a civil penalty of not more than five hundred dollars ($500).
O'I, 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.)
O 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) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Sq. Ft. No. No. Dw.
Size € 00 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT r
_ ' AMOUNT
Plan Chk. Dep.
Distances:
Plan Chk; Bal.
76.05
Const.
Ll7.00
Mech.
'
Electrical
Side Setback from Property Line
Plumbing
FINAL DATE
S.M.I.
0
Grading
Validated by:
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
.Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL 193.75
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This sction need not be completed if the permit,. Is for one hundred dollars ($100) valuation - r'L,--'AMi.•„v,,,,,tis,. ..ir„'«•w
or less.)(•t.'i!. .d`:L F rY wF•�r vrM' ..YRu?+,:,. x-�.a y
I certify that in the performance of the work -for -which this permit is issued, I shall not
employ any person in any mann o•as to becom'e..subject.tthWorkers' Compensation
Laws of California
Data ;.Owner r i , 6 -
NOTICE
NOTICE TO APPLICANT: ;1e/ter "aking,this Cer'tHkal6NOI„Ezemption you should become
subject to the Worliersrs' Compensabort-proGisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. .
CONSTRUCTION LENDING AGENCY
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.)
Lender's 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:,
iaY ;7c. r., t. 1A'L �S'.a '�' ,S" f I +.. r. - .t.. -z .C� � it r .s + • •e• .: i. . . 'i `- :% t
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BO 6NGl
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC1.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. 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
W ER SYSTEM
WATER SOFTENER
VENTSYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
�(Z �l t Gd
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
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BO 6NGl
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
WATE EATER
SERVICE
FINAL INSP.
BOND BEAM
W ER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING Q�( C Q
FINAL INSP.
ROOFING
VENTILATION
`� G� v�(s
�(Z �l t Gd
REMARKS:
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