14344 (AR)Building
Address
Owner
P.O. BOX 1504
78-495 CALLE TAMPICO
78-745 bg3st; nso LA QUINTA, CALIFORNIA 92253
R^hfC —t' Tai "el
BUILDING: TYPE CONST. OCC: GRP. R3
A.P. Number
No. 14344
Mailing
Address P.O. Box. 611
City ZipTel.
Corona Del Max , CA 926251.(714)673-4840
Contractor
Vir_cent J. Rogers: D.D.A. Synergist Grou:
Address
74a-741 ,ion} Drive Suite C
itylZip T l '
CPim Desert, 92260 C619p.346-3939
State Lic. B 563694 City
& Classif. Lic. #
Arch., Engr.,
Designer Brian Gottlieb StrUc . Eng.
AKafe S35 Via f orona T015,19) 569-3553
Baa diem wells* CA 922 .0 Lict# C3304-7
LICENSED CONTRACTOR'S DECLARATION
.1 herebyy'affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 00) of'Div'ision 3 of the Business and Professions Code, and my license is in full force and
Affect. l iAa
OWNER -BUILDER DECLARATION
I hereby affirm that I 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 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 civfl'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 withinone year of completion, the owner -builder will. have the burden
of proving that he did not.buikl or improve for the purpose of sale.) ..
❑ 1, 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 of propertywhobuilds or improves thereon, and who contracts for
such projects with -a contractor(s)pcensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. & P.C. for this reason
Legal Description
Project Description Interior alteration
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑. Repair ❑ Demolition ❑
Estimated Valuation $L5 r 000. uo
i
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I 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.)
Poli yNo�� Company
atopy is filed with the city, O Certified copy is hereby furnished. -
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
INSURANCE
WORKERS' COMPENSATION
(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 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
AMOUNT
105.30
162'. 00
1.50
Date Owner
. NOTICE TO APPLICANT., H, after making this Certificate of Exemption you should become.
ZONE:
'BY:
subject to the Workers' - Compensation provisions of the Labor Code, you must forthwith
Minimum Setback
Distances:
comply with such provisions or this permit shall be deemed revoked. ,
Front Setback from Center Line
Rear Setback from RearProp. Line
WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL, AND
• Sldt? Street Setback fro R1 er Line
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, ...
_
Side Setback from P y Line
DAMAGES AS PROVIDED FOR IN SECTION "3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
FINAL DATE
I EC
Ttiis is a buiidin g permit when properly filled out, signed and validated, and is subject to
j 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. ,
Issued by:
Date rmit
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
1
City, State. Zip
- ,
.. -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINu FEESs`S;
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
2ND FL. SQ. FT.
FORMS
YARD SPKLR SYSTEM
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH).
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CA R, P. SO. FT.
TEMP. POLE
DRAINAGE PIPING
WALL SD. FT.
GROUT
DRINKING FOUNTAIN
SQ. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
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
SO. FT. a c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
INSULATION/SOUND
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 APP.IEQUIP.
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
l
�(� V
/
4 o7
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESlINITIALS
GARDEN WALL FINAL
R'EP— 2—V15 THU 6 T 1 A MOVER I NS V V AT I'ON
L1
Ilii
,N ap
Or MPVIN% " R ANC L.
O A QUINT',A.
�7 'rph k•nv k I. 1)f 1l Au1Y ce.1.I1-UNNI4
COO
REQUEST FOR ARCHITECTURAL MOOMCATIONS
Anolicant's %M' e., kit. i M."... 06"_mo 1-.10" MOP,
TO THE AACIMCTO1RAL COiv MMEB:
Yom aro horoby 664W that Vwob vti wo* b $oo and u rovat k Atuwh to a drawing ofthe :' VIk to bv:aonQ-' or..
ftWoriafo to be tt$olt :ledt *0 oa tiw drawings. Wa undents+ad tha! pwmite to AoMkgW *ft ero rnuired by Q!0' of
L6 Q414 And 1�atlho coat OMpomll4 and rotypaiaihlfity of oLtait g :. a end evb lnfr�0u1la *M be bOm by 11w p*llw&
Wo aekrwwlOV *g aQ OPPMVW dtangew 1n tho arIOW 4011 wul bo stow CXP&40; Umd orry ipd i11 darao� o.. to twfiaWng wtf 006; or
OW doomso tawltI &M tho oonvlraetion orche p�opo"d lti►provoaieid.441 be et our (O;v tiOq.e;a)enSO, Oft!"A.Hy
etWWxOwwo OrOw g�attttltlad kvMVt MMU $hall. be al ibo SYPOW my exPte MW tha "Olms a�pfooilo Iwhj ON Ratu�f,O:Lu i
Rold"41 IIohiMi ro A$tebW" Aarrritew for the ao$t dMIL tOM" eriame. Ha+aowne< a to 14,614 , daibnd bold
10MI0101406o 141 QuiMo It AOVAgal A&VCletloo, Ito of im, ai an0. mnptoyoa kem arty llpt+ijWr a ULV N eiatovi O tAhi
epplluatlo><
Signatures of all owners: .
ARCHITECTURAL:COMMITTE9 '
Approved:; Conditionaltygpproved: blsnppraved;;, ,,,�
Reason for conditional approval or disapproval:_
Date: Signature.
(ARA ChAnr m)
itta additlon to this approval, you must obtain City approval for requested modifltatlti)a'
(where applicable) plus any othor necessary buildirt$ permits.,
t at oneOwd o y) (uso
dddoo'p4oluNcjTON $'rkuMr • 1'.0. 14Ox 1112 • LA Q11INYA, CA 42201 a big -V1•'/'!66