002172 (AR)44
P.O. BOX 1504No.�
Building 78-105 CALLE ESTADO
Address 80-071 Island Drige LA QUINTA, CALIFORNIA 92253
Owner -
Mailing
V'•�"Ch iat8�2 BUILDING: TYPE CONST. OCC: GRP.
Address � A.P. Number
City Zip Tel.
JA Quinta 92253 Legal Description
Contractor Project Description
Address .. _
78-341 Mrby Road -
City fioTel:��yy
l� 9=1 345-13497
State Lic. City
& Classif.�� Lic. # Sq. Ft. No. No. Dw.
Size Sq. . Stories - Units
Arch., Engr.;
Designer New ❑ Add Ou Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State Rom a&Utk t.
Lic. #
LICENSED CONTRACTOR'S DECLARATION j
I 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.
SIGNATURE .Y '" DATE
OWN ER•BUILDER'DECLARATION Estimated Valuation
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 4.800.001
_
permit 'to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to '•PERMIT - t� AMOUNT
.the provisions 0/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3' o/ 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 - .. Plan Chk. Dep.
subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500). `3
❑ I, as owner -of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 32.82
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const..ts,{i
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, . McCh. '
provided. that' such improvements, are not intended -or offered for.sale. If, however, the building �q x
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 12.00
o/ proving that he did not build or improve for the purpose of sale.) _--
0.I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the -project. (Sec. 704 4,. 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 S.M.1. . .Rn
such projects. with a contractor(s) licensed pursuant to the Contractor's License Law.),
Grading
❑. I am exempt under Sec.. B. 8 P.C. for this reason
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
❑ Copy is filed with the city.... ❑ Certified copy is hereby furnished.
TOTAL y�+tiit:
CERTIFICATE OF EXEMPTION FROM REMARKS.
WORKERS' COMPENSATION INSURANCE
(This section need not be completed lithe 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 ZONE: BY: _
subject to -the 'Workers' Compensation provisions' of the Labor Code, you must forthwith .Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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 forwhich this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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. mut
.I certify that I have read this application and state that the above information is correct. Issuedby- Date +'— CPermit
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. Validated by:
Signature of applicant I 7 Date
Mailing Address t t '�� ` Validation:
City, State, Zip
A4726 3 11 5�'82 Sl
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
2ND FL. SQ. FT. @
POR. SO. FT. @
GAR. SO. FT. @
CAR P. SQ. FT. @
WALL SO. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
" UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM .
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR @ 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE tPLL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
T,
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
C
a
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL . .
UN'5 WUNAI VKhW1NITIAUk
GARDEN WALL FINAL
0
CITY OF LA QUIN'TA
Community Deveiopmen-UBldg. Dept.
CONDITIONALLY
ACCEPTED FOR � ik Ill
Fc)o Dri v V-
kovoew
�� � X
oc?
ID
Lis
CITY 01: LA QUINTA
COMMunity Dqcelz
OPRIerit/Sidg. Dept.
COM
PT
ACCEPTED. Fmiti
SUB; C. 67, ct
Tj M-;tLER
AN"D ES
q '—� �,4
�. a
CITY OF LA QUINTA
Community Developff-jerwBidg, Dept.
CON, A'�LY
ACCEPTED FUR
SUBIE(:y To
----------
AND
DATE