The URL can be used to link to this page

12763 (PLBG)P.O. BOX 1504 Building 51-289 Desert Club Fir. 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Kenneth 9. Mitchell maning Address 52-475 Ave. Carranza CityZip Tel. La Quinta r C 92253 Contractor Burgess Builder Address 81-263 Pala verde %radio, CA zip 322{33 Tel: 347- 852I State Lia City Classif. $ 541464 Li2222 Arch., Engr., Designer Address Tel. City Zip State Const. Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 000) of Division 3 of the Business and Professions Code, and my license is in full force and RRRYeffect. RRR P SIGNATURE 7=A DATE OWNER -BUILDER DECLARATION I hereby affirm that I 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 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 I subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will i 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 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 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 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.) 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) 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 �ws of California. !� `D'ate X12' Owner, 7VOTICE TO APPLICANT: If, after making this Certificate o1✓Exemption you should become •subject to the Workers' Compensation provisions of 166 -Labor Code, you must forthwith comply with such provisions or this permit shall 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.) 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. 1 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 No. 12763 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Relocate ~.later heater, add Project Description n, isc. pluvd)ing fixtures and minor electric fixtures Sq. Ft. No. Size Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $2r500.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical 15.00 Plumbing 31.50 S.M.I. Grading Driveway Enc. Infrastructure TOTAL 46.50 REMARKS ZONE:— minimum ONE: Minimum Setback Distances::;;) ., Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street etb,pck from Center Line Side Setbackj. m Pr9 erlty Line FINAL DATE— INSPECT ! . ° Issued by: �& /Dat'e Q .Permit rA Validated by: /1/// Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SQ. FT. 0 STORAGE TANK FORMS J SEWER OR SEPTIC TANK MOBILEHOME SVC. BAR SINK POR. S0. FT. ® ROCK STORAGE FOUND. REINF. GAR. $0. FT. p POWER OUTLET ROOF DRAINS OTHER APPJEQUIP. DRAINAGE PIPING CAR P. SO. FT. ® TEMP. POLE WALL SO. FT. ® DRINKING FOUNTAIN WATER HEATER SERVICE URINAL SO. FT. ® BOND BEAM ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation LUMBER GR. FLOOR DRAIN MECHANICAL FEES FINAL INS P.3— -0/ - WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED �Gis `^ell LAUNDRY TRAY AIR HANDLING UNIT CFM FRE ZONE ROOFING 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 LATHING L,0 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/a c SEWAGE DISPOSAL 6vt:hu Ila SO.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING d GAS PIPING PERMIT FEE FINAL INSPECTION '-A —�Za--CIT PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTUREA /l .PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACKOUND PLUMBING a,eX (_4 JDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS J 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. 3—�G FRAMING .3lo- y Lo / FINAL INS P.3— -0/ - ROOFING rD REMARKS: VENTILATION �Gis `^ell o <Lit CT . FRE ZONE ROOFING C �� ` y{7 n -i FIREPLACE �T ✓7J SPARK ARRESTOR GAR. FIREWALL 3—/� Ly { s OL ter LATHING L,0 l MESH 6vt:hu Ila INSULATION/SOUND FINISH GRADING d FINAL INSPECTION '-A —�Za--CIT CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL