9820 (RER)44a
P.O. BOX 1504 No. 9-820
Building 78-105 CALLE ESTADO
Address 4€3507 iiia Enna 3t� LA QUINTA, CALIFORNIA 92253
Owner
Nancy Borden BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 485501 Tia Enna nto A.P. Number
C?Zy Zip Tel..
La Quinta 92253 Legal Description
Contractor Project Description
Owner/Builder
Address 2 Windows
. ,City lZip - Tel.:
State Lic.I City
& Classif. Lic. #
Alull., r=nyr.,
Designer
Address Tel.
CityZip State
Lic. #
1.
LICENSED. CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) rofI D' vislon 3 of the Business and Professions Code,fand my license is in full force and
t
effect. / '� t`:`'l Ci_, I ? tQ I,�i,^ate .
SIGNATURE J, - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Busfness and Professions Code: Any, city or county which requires a
Permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Ole 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 civil penalty of not more than five hundred dollars.($500).
Mlrl, as owner of the property, or my employees with wagesas 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,intanded-or offered for sale. If, however, the budding
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 bf-consentto self -insure, or a certificate of
Worker's Compensation Insurance, ora 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 pemtit 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.
Dale 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 provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY '
Ihereby 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 it work thereunder is suspended for 180 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 Address
City, State, Zips
TOTAL
REMARKSg /y
� V�•, yj d•l�k t9 � ji T i -S �t'i C_' n+e+ S 0
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. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ -Demolition ❑
Estimated Valuation
506 Qa
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKSg /y
� V�•, yj d•l�k t9 � ji T i -S �t'i C_' n+e+ S 0
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
IST FL SO. FT. ® $
2ND FL SO. FT.
FOR. SO. FT. ®
GAR. SO. FT. @
CAR P. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
v
NOTE Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
OTHER APPJEOUIP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEWPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
WATER SYSTEM
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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 APPJEOUIP.
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
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
y, 1)E -I.A PAZ
ARCHITECTURAL VARIANCE REQUEST
U n I t '# ` Date•
Street Address / 0x
Local Phone y_ l(.1Q / Other Phone
To the Architectural Committee:
."we, the -O dersigned owners, req.uest your approval of the
modifications.'proposed on. the reverse side o"f'this.form.
Attached are dr"awings of the work to be d'one.; types of,
material to•, be used are indicated. on the drawings. we
understand that b"uilding permits for home imprDvements are
required by the City of La Quirita and that the cost of the
permits and responsibility' of obtaining per.mits-" and'
subsequent inspections will be. borne by 'us.
we ackowledoe that all .approve.d changes in the original
design will beat our expense; t.h'at any damage to or
relocation, of- existing sprinkler systems, underground
utilities, building structure and exterior landscaping or
other 'damage: resulting from construction of .these permitted
improvements will be at our expense; and that maintenance of
the permitted improvements will be at our expense. -
Signature of all owners: C �dUL.CJ�-rJL—�
�l�l/ Y 1
T
4'
Please pr2vide as much detail as possible so that the
Committee may consider approval without delay!
__fa� 0.1
lip
The above proposal has been reviewed by the Architectural
Committee and has been:
APPROVED REZECT_+i O PENDING FURTHER
INFORMATION O
Comments:
DATE:
Committee Committee Comm i: a e
/ Member Memoer Member