08792 (RPL)Building
Address
Owner
Address P.O. Box 1789
TWIf 4
lGfGtl.
P.O. BOX 1504 No. 08792
78-105 CALLE ESTADO
ar LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
City Zip Tel.
La .Quanta 92253
Contractor
Daniel Been
Address .
Zip I Tel.-
& Classif. A72042 I Lic. #
Arch., Engr.,
Designer
Address I Tel.
City
r� .1
70
efl
I Zip I State
Lic. #
9 (commencing with Section
my license is In full force and
-�� vvnen-ourLuenuccuAnwtIUM ---
I hereby affirm that I am exempt from the Contractor's License law for the following
reason: (Sec. 7031.5,Business and Professions Coder Any city or county which requires a
permit to construct, after, improve, demolish, or re
Palr any structure, prior l0 Its Issuance also
requires the applicant for such permit to file a signed statement that he Islicensed pursuant to
the provisions of the Contractor's License law, Chapter 8 (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 v/o/aflon o! Section 7031.5 by any applicant for a permit
subjects: the applicant to'a civil penally of mol more than five hundred dollars ($500).
❑ I, as owner 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, Sulsness and
Professions Code: The, Contractor's License Law does not apply to an .owner of property who
builds, or koproves thereon and who does such work himself or .through his own employees,
provided that such Improvements are not intended or oHered:forsale. If, however, the building
or Improvement is sold within one year of completion, the owner -builder will have the burden
ofproving that he did'rot build orknprove for the purpose ofsale.) I .
❑ 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 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 Willed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed n 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
=any person in any manner so as to become subject to -the Workers' Compensation
Laws of California:
Date Owner
NOTICE TO APPLICANT: N, after making this CertBlcate :of Exemption you .should become.
subject to the Workers' Compensationprovisions 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.)
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 thereunderis suspended for 180 days.
I certify that I have read this application and state that -the above Information'Wcorrect.
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
Malling Address
City, State, Zip
P. Number
Description_
t Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
76.05
Const.
117.00
Mech.
24. 0
Electrical
45, 00
Plumbing
27 .00
S.M.I.
.70
Grading
Driveway Enc.
Infrastructure
TOTAL
289,75
REMARKS�•,
�, , •„ , s
At
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. ® $
UNITS
SLAB GRADE
2ND FL. $O. FT.
BONDING
YARD SPKLR SYSTEM
POR SQ
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ. FT. 0
OTHER APPJEOUIP.
REINF. STEEL
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN,
SQ FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION i
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR,DRAIN
MECHANICAL FEES
=i
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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
SPARK ARRESTOR
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3Ac
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
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
i plus xi
=i
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL