10860 (RR)At_
Building
.4 4v Q*
P.O. BOX 1504
78-105 CALLE ESTADO
78--065 La Fonda LA QUINTA, CALIFORNIA 92253
keari 2�i` iflllir
Mailing
Address P. 0. Box 1542
City Zip Tel.
Iia Quinta . 92253
Contractor
. Spraykote Systems
Address
P. 0. Box 638
City Zip Tel.:
,000 Palms 92276 343=2022
State Lic. City
& Classif. C39 306653 Lic. # 304,
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
`7 of Division 3 of the Business and Professions Code, and my license is in full force and
`ffecL _,_ s '1%f ' -/
SIGNATURE /J x DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors 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
Me provisions of 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 . appficant for a permit
subjects the applicant to a civil penalty of not more than five hundred doliars.($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. 11, however, the buRdng
or 6nprovement is sold within one.yearof completion, the owner-bufider will have the burden
of proving that he did not bufid or improve for the purpose of sale.) .. - ..
❑ I, as owner of the property, am exclusively contracting.with licensed contractors to con
struct the project (Sec., 7044,. 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.)
•❑ 1 am exempt under Sec B. & P.C: for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, ora certificate of
Workers Coy pYen� �n vnv vLova certified toAhe�e�ofi(YSei3�800.1�aDor Code-)
Policy No.Company
❑ Copy is filed with the city. ❑ Certified copy is.hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) vahration
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 owner
NOTICE TO APPLICANT: d, after making this Certificate of - Exemption you should become
subyect 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
1 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.)
Lenders Name
Lenders 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
o. 10860
'3.
BUILDING: TYPE CONST:' OCC: GRP.
A.P. Number
Legal Description
Project Description
ZONE,
Reroof
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Sq. Ft.
Size
No.
Stories -
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
Estimated Valuation
4P 500
PERMIT
AMOUNT
-Plan Chk. Dep.
Plan Chk. Bal.
Const.
20.00
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
20.00
REMARKS
UY 41t i`,%A <NV `=
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
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
2ND FL. SO. FT.
POR. SQ. FT. @
GAR. SQ. FT. @
CARP. SO. FT. ®
WALL SQ. FT. @
SO FT @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
-
r
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE:. Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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 @ 1% 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 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 Z
��
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
7d