15867 (RER)No. 15867
+' P.O. BOX 1504
Building 4• 78-495 CALLE TAMPICO
Address 48-517 t�'ia �:nca7's�ii LA QUINTA, CALIFORNIA 92253
Owner
Mailin
Address 48-51.7 Jia Encanto
City p Tel.
iia Quinta 792253 ..564-0743
Contracto Larry Guru Con.-ttiuction
Address 15320 katrQnella I
City Zip Tel.:
Gardena 94249 314-579-731
State Lic. City
& Classif. 424L48 Lic. # 27139
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under ProvisionsofChapter 9 (commencing with Section
7000). of Division 3 of the Business and Professions Code, and my license is in full force and
'effect'
SIGNATURE r.iy"' !` 'r "DATE
V' 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, after, 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 civil penalty of not more than rive hundred dollars (8500).
❑ 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 within one year of completion, the owner -builder will have the burden
of proving that he did not build or irnprove for the purpose of sale.)
❑ 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) (fcensed 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 subjecthe Workers' Compensation
Laws of California
Date iJ'':%lt% Owner,r"��-•�/':��d'LNTicTo"C
aftergeate on iyoushould Decame
subbCl to the Workersnsationpronsofthe rCod'youmust forthwithcomplywithsuch provisions or this permft shall Deemed revoked.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
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,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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 certlfy that 1 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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description ACM 24" X 32's Glass Slock
Glock wall in master bath outside call
Sq. Ft. No. No. Dw.'
Size Stories Units
New ❑ "Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $350.00-
PERMIT
350.0Q
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
9..75
Const.
15
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
S25- 4 251
REMARKS '
ZONE:i 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 /�� n
Validated by: M /A- \ I I
Validation: I
OCT 19 19
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES 1
A.C. UNIT
COLL. AREA
SLAB GRADE
IST FL. SO. FT. ® $
UNITS r
HEATING (ROUGH)
2ND FL. SO. FT.
FORMS
YARD SPKLR SYSTEM f
POR SO FT ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. A SO. Ff.
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SO. Ff.
TEMP. POLE
DRINKING FOUNTAIN,
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PPL.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.
$ plus x$
=$
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 SIGNATURES/INITIALS
GARDEN WALL FINAL
` Laguna De La. Paz
P.O. Box 799 s
Rancho Mirage, CA 92270
(619) 564-8864
t
FAX (619) 554-8867
ARCHITECTURAL VARIANCE REQUEST
UNIT # / DATE �Q of cf S
NAME z. O S C 12P 4 7—A kc- P!4/(5�W
STREET ADDRESS jT ,�/ '� V1 70 '
LOCAL PHONE # `-1 U ��-� OTHER, PHONE
To The Architectural Committee:
L
We, the undersigned owners, request yourapproval of the .
modifications proposed on the reverse side of this form.'
Attached are drawings of the work to be.done;stypes.of'material
•to.be used are indicated on the•drawings. We Understand that
building permits for home improvements' are required by the City
of La Quinta and that the cost of the permits. and.responsibility
of obtaining permits and subsequent inspections will'be borne :
by
t{ .
We acknowledge that all a '
g approved changes in the original design
will be at our expense; that 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 implrovements
will be at our'expense.
$ SIGNATURE OF ALL OWNERS : _
Please provide as much detail as possible so that the committee
may consider approval without delay!
•
allgA &3e I'A7 7�Z'
The above proposal has been reviewed by the Architectural
•L Committee a d has been:
APPROVED /PENDING,-
APPROVED
Y
REJECTED PENDING: FURTHER,
INFORMATION
Comments:
Of
Committee Member
Committee Member
Committee Member
Committee Member