13196 (RER)I V
�.� P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 78-910 La Palma Str*e't LA QUINTA, CALIFORNIA 92253
Qy:.:rs .
1!5 Pv,;- A-ZJ
Mailing
Address She
CityTel.
La Quinti, C Zip 92253
Contractor
All Phases Constructione Inc.
Addrss
5560 Pomona Blvd. , Ste.' 100
City Zip Tel:
Los Angeles, C& 90022 (213)887-5010
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City I Zip I State
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed undo} provisions of Chapter 9 (commencing with Section
`e000) of DivisioA 3 of the Business and"+P¢rofessions Code, and "y license is in full force and
ffect. !�7 v=}
_SIGNATURE .r a i DATE
y �' OWNER -BUILDER DECLARATION
I hereby affirm that, 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
requires 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 or 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 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 hot 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
Date Owner
WORKERS' COMPENSATION DECLARATION
I Zopy0is
by affirm that I have a certificate of consent to self -insure, or a certificate of
Workempensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy Company
[D. filed with the city. O Certified copy is hereby furnished.
V CERTIFICATE OF EXEMPTION FROM -
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100),,valuation'
or less.)
I certify that in the performaAce 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.
CONSTRUCTION LENDING AGENCY
Ihereby 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 stale 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
ateMailing Address
City, State, Zip
No. 13196.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Extend bathroom for
wheelchair access.
TOTAL I WO.O u
REMARKS
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:
Sq. Ft.,
Size-_•-.-^' "
No.
Stories-
No. Dw.
Units
NewO Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$31,801, 00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. , -
CP
P
Const.
Mech.
FZ
21.00
Electrical I
Plumbing
17.15
127.00
Grading
Driveway Enc.
Infrastructure
TOTAL I WO.O u
REMARKS
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
f
NO. PLUMBING FEES `•
IST FL. SQ. FT. ® $
UNITS
A.C. UNIT
r
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WIRING
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
" CAR P. SO. FT. ®
HEATING (FINAL)
WALL SQ. FT. p
REINF. STEEL
DRINKING FOUNTAIN,
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: -Not -to be used as property tax valuation
FLOOR DRAIN
=- MECHANICAL FEES-
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH) "
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT ' CFM
FRAMING
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
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/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.
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
/ /" • U
pY ��(/ N
7/2
y^
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
?s ,
25
1
N
?eL P05E D
AonrrioU
CITY OF LA QLjiNTA
INC &
ED!
tTo
AND ALL
TE -2 -19 � 3
LA'i-
ARTMENT
AS PER
CITY OF LA QUINTA
WILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCE04ED FOR CONSTRUCTION
ION AS PER
Jr
c -
AND ALL APPLICABLE CODES
DATE ` t
ZLr CLL
(r -y P.
CR�ss s��TI oz�
ATI D 1,4
2 x
TV P.)
L, rv, Lee IJ6- Tc 711' Im EXISTI.IA& I Top PLA-r:::7r
• 2'x L..
• K --3`B I N Q L- - r6 Wt U N CGI. 06,--
T� -rl EF 1 (s -To F4 . .... .0. c
• '�lJI1,:�; ; V,�. �ALV� Ta Be .7S
TR P:TPEr;•-
To TITLE 2� AND
CITYOF LAQUINTA
BUILD NG & SAFETY DEPARTMENT
'CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
DATE BY