05862 (RPL)Building 53475 Aire Herrera
Address
Mark Mker
c&ty/ 4
P.O. BOX 1504 N o .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address
City La Quinta Zip 92253 Tel^
Contractor owner/Builder '
Address
Citv ZiD Tela
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE _ DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,s and Professions Code: Any city or county which requires a
permit to construct, after, improve, demofrsh, or repair any structure, prior to its issuance also
I- requires the applicant for such permit to lie a signed statement that he is licensed pursuant to
. the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Busahess and Professions Cade, 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 civilpenalty of not more than rive hundred dollars ($500).
Iy O 1, as owner of the property, or my employees with wages as their sole compensation, .will
til • :i19 the work, and the structure is not intended or offered for sale. (Sec. 7044, 0uisness and
Professions Code: The Contractors License Law does not apply to an owner of property who
builds ormproves 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
If or improvement is sold within one year of co mplelion, the owner -builder will have the burden
of proving that he did not build or krprove 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 property who bu*b 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
u
Date rf, ;. r Owner
i, WORKERS' COMPENSATION DECLARATION
pp I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
ISI Workers 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.) r
I certify that in the performance of;thp work for which this permit is issued, I shall not
employ anyperson in airy manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner ....".�•-lei 1� r f`f• ^-L..- •-----•...,,...r
NOTICE TO APPLICANT: If, after ma/6hg this Certiffe of Exemption you should become
subject to the Workers' Carrpermffon' provisions of the 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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 1110 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 Add ___s _-
City, State, Zip
BUILDING: TYPE CONST. • OCC: GRP,
A.P. Number 774-053-M5
Legal Description
Project Description P001
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. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
r
Estimated Valuation
6000.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
90.00
Mech.
24.00
Electrical
30.00
Plumbing
27.00
S.M.I.
.49
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
yarn.;f�ra►� ' ta:'�r,Tra1:kYcn'z..tsy rt �u
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. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT. g
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CARP. SQ. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SQ. Ff.
DRINKING FOUNTAIN.
SO FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
-Plus-x$-=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
_ o
1
LAUNDRYTRAY
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
SPARK ARRESTOR
SQ. Fr. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® V4c
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
FINAL INSPECTION
CERT. OCC.
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
/ GROUND PLUMBINe, % _
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
_ o
1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
`
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL