14452 (TT)t , P.O. BOX 1504
Building 50-040 Indian Camp Roach. 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
( Owner 2 inistrelli Development
Mailing
Address SO--445lountai n' Shadows
Cityip TI
.
La . Quinta i CAF. 92253 564-1849
Contractor
• sc-me
State Lic.
& Classif. .
Arch.,-Erigr.,
Designer
Address
City IZip
LICENSED CONi
j I hereby affirm that ,din licensed under
000) of Division"3'oi the'Business and Pi
r1 eeffect. ,v` ✓,rte. _.Ao
City
Lic. #
Tel.
Lic. #
DECLARATION
)f Chapter 9 (commencing with Section
;cde, and my license is in full force and
No. 14452
BUILDING: TYPE CONST._ -_ OCC. GRP.
A.P. Number
Legal Description
Project Description -
State
Trailor
Sq. Ft.
Size
New ❑
No.
Stories
Add ❑ Alter ❑
No. Dw.
Units
Repair ❑
G
Demolition ❑
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: .(Sec.. 7031. 5,Business and .Processions Code: Any city or county which requires a
Estimated Valuation
permit to construct, alter, improve.. demolish, or repair.any structure,-. prior to its issuance also
requires the applicant for such permN.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 Prolessbns Code• or that. he is exempt therefrom, and the basis,
for the alleged exemption. Any violation'ol Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ 1, 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
or proving that he did not buil! or inprove for the purpose of sale.) •.•-
- PERMIT AMOUNT
' Plan Chk. Dep.
- -
Plan Chk. Bal. 2
Const. ' e.
'
Mech.
Electrical -
Plumbing
❑ 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
S.M.I.
does not apply to an, owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) (lcensed pursuant to the Contractor's License Law.) .-
O I am exempt under Sec. R. g P.C. for this reason
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION ..
Side Setback .from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND'
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worke'p,Compensation Insurance, or certified copy thereof. (Sec. 3800, Labor Code.)
Polic /No. Company
Copy Is filed with the city. . O Certified copy is.hereby furnished.
FINAL DATE
TOTAL . a3
expiration if work thereunder is suspended for 180 days.
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 thg 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 Perm• .
Date Owner.
NOTICE TO APPLICANT. N, after making -this Certificate_ of Exemption' you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code,., you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES' AND CIVIL FINES UP. TO ONE
HUNDRED THOUSAND DOLLARS.($100.DDD), IN ADDITION TO THE COST OF COMPENSATION,
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 properly filled out, signed and.validated, and is subject to
FINAL DATE
INSPECTOR t
expiration if work thereunder is suspended for 180 days.
_
1 certify that I have read this application and state that the above information is correct.
Issued by:
Date Perm• .
I agree to comply with all city and county ordinahces and state laws relating to building.
IL
construction, and hereby authorize representatives -of this. city to enter the above..
t
1
Ll 21
InT
mentioned property for Inspection purposes..
Validated by:
Signature of applicant Date
Mailing Address
Validation:
nF P. 19 1994
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. 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
&KWAL 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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c .
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ic
HOUSE 'SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL:CK.FEE
CONST. FEE ELECT. FEE 7
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
LUMBER GR.
&KWAL INSP.
FRAMING
FINAL 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