05196 (SFD)Building
Owner
c&t�/ 4 4 Qs'
P.O. BOX 1504
44-'12-5* DMlea Circle LA QUINTA, CALIFORNIA 92253
La Quints Associates
maffing
Address 43-875 V
City lZir
City lZip I Tel.
State Lic. City
& Classif. 493919 Lic. # 1231
Arch., Engr.,
Designer
Address Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) t.of Division 3 of the Business and Professions Code, and my license is in full force and
effec
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirTn that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Busiress and Professions Code: Any city or county which requires a
permit to construct, after, improve, damoksh, or repair any structure, prior to its issuance also
requires the applicant for such permit to Me a signed statement that he is licensed pursuant to
the provisions of the Conbactoes License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of 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 civilpenally 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, Suisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or inproves thereon and who does such work himself or through his own employees,
provided that such improvements are not'mended or offered for sale. g, however, the building
or improvement is sold wftlein 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 with licensed contractors to con-
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKED' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy'No. Company
b Copy is filed with the city- ❑ Certified copy is hereby fumished.
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 perforinence of thF work for which this permit is issued, I shall not
employ any person in airy 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 prova om or this permit shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
I 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 certity 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. 05195
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number CAC-tttR FIOTXet
Legal Description
Project Description VIlAQtt-- T, PTA -A 4AR; T,nt 23
Sq. Ft. 1887
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$88,500
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 356.68
Const.
430.00
Mech.
36.00
Electrical
78.89
Plumbing
82.00
S.M.I.
6.90
Grading
Driveway Enc.
Infrastructure
2,221.98
TOTAL
$3,212.45 .1� ,.
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 /
i2J29/88
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF. S Q
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL)Wo, 7109' �ZAmi`- POLE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. I SO. FT. ®
WATER SYSTEM
GRADING
cu. yd.
plus x$
WALL SQ. FT. ®
LUMBER GR.
DRINKING FOUNTAIN
SO. FT. ®
FINAL INSP. �/ 7 ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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, TEMIPERM
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.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
FINAL INSPECTION
SQ.FT.GAR ® 314c
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE—j PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
r-7Lr�.
SETBACK
GROUND PLUMBING ®< UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEA TA ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. S Q
GAS (ROUGH) p� ETER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
REINF. STEEL
GAS (FINAL)Wo, 7109' �ZAmi`- POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING /L*
FINAL INSP. �/ 7 ®
ROOFING 6 2
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND 17/2
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL