15802 (RPL)Tit,
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 79+-710 Iris Ct LA QUINTA, CALIFORNIA 92253
Owner
Grandville "Bruce" Kay
Mailing
Address 79-710 Iris Ct
City Zip Tel.
La Quinta 1 92253
P001 const
Address
78-'931 41' Ave
Dunes 92'201.
State Lic. City
& Classif.. ILic.# 20.5+
Arch., Engr.,
Designer.
Address Tel.
City " Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
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 DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec.. 7031.5,Bus1ness and Professions Code: Any city or county .which requires a -
'permit to construct, after, 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 Cade, 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 civil 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
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 withlicensed 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 coniractor(s) (lensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
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. ,
,l
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(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 thg work for which this permit is issued, I shall not
employ,any pperson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: B, 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.
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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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. 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.
Signature of applicant Date
Mailing.Address
City, State, Zip
No. 15802
LDING: TYPE CONST. • - OCC: GRP.
P. Number
Legal Description
Project Description '
P001 Sia
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add•❑
Alter ❑
Repair ❑ Demolition ❑
Side Setback from Property Line
FINAL DATE
INSPECTOR
y
Issued by:
Date Permit
Validated by:
in n
n
Estimated Valuation
$11, 050 .tib .
PERMIT
AMOUNT
Plan Chk. Dep. ,
Plan Chk. Bal. i
87.75
Const.
$135 . 00
Mech.
$ 24.00
Electrical
$ 45-000
Plumbing
'r 27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
$318.75
REMARKS
1
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
y
Issued by:
Date Permit
Validated by:
in n
n
Validation:
U 2 3
1995
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPIEQUIP.
DRINKING FOUNTAIN.
SO 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 INSPI
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® Vic
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 I �J HEATING & AIR COND. SOLAR
SETBACK,
GROUND PLUMBI G
UNDERGRO �'
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUM !� '.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SE C TANK
ROUGH' WIRING
DUCT WORK
ROCK STORAGE' '
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING'
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSPI
FRAMING
FINAL IN P.
ROOFING
r (�
� Z'
mee
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION-
NSPECTION CERT. OCC.
CERT.
FENCE FINAL - -
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL