14098 (RER)r+�
Building
Address
M
48Y-526 Via Rncanto
Jennie Robinson
Mailing
Address Same
P.O. BOX 1504 N Q .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
4
BUILDING: TYPE CONST. OCC: GRP.
A.P -Number
City Zip Tel. [
La Quinta f1 C11 92.253 1 564-5580 Legal Description
Contractor.. • �' f .. °Project Description Remodel
Larry Gumtz Coustruceioz
Add�U- 365 y ill i Suite 148
City_ a Quintas Ci zlp 92253 Tel. 564-6927
State Cla Lic. B 424048 City 2759
& Classif. Lic. #
Arch.,-Engr:, -
Designer
Address Tel.
City( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm -that I am licensed under provisions of Chapter 9 (commencing with Section
7Q00) of Division 3 of the Business and Professionsl ode, and my, license is1gfWhforce and
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, 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 or 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 ($500).
❑ I, 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 improve for the purpose of sale.)
❑ I, asowner 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 or 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 Com ensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Pol iCy, No Company
'o �y,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 the work for which this permit is,issued, I shall not
employ any person in any manner sc as to become subject to the Workers' -Compensation
Laws of California: � �.yf`��¢
ate . <§% OGrner _ .'�7�`fi"�3 x-
-
NOTICE TO,iAPPLI_CANT: It, after making this Certificate of Exemption you should b� e
,5uwbject to /the Workers' Compensation provisions o1 the Labor Code, you must forthwithi
comply with such provisions or this permit shall be deemed revoked. YYYYYY
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.
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 stale laws relating to building
construction, and hereby authorize representatives -of this city to enter the abcve-
mentioned property for inspection purposes.
Signature of applicant -Date-
Mailing
ateMailing Address
City, State, Zip
14098
,
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
_
Alter ❑ Repair ❑ Demolition ❑
Side Street Setback from Center Line
. II
Side Setback from Property Lie
FINAL DATE
INSPECTOR
Issued by:
Date 4A, —Permit,/ 1) �+
Estimated Valuation
$6,544.00
k
PERMIT
AMOUNT
Plan Chk. Dep.
Validation:
Plan Chk. Bal.
58 .50
Const.
90.00
Mech.
Electrical
Plumbing
S.M.I.
. 65
Grading
Driveway Enc.
Infrastructure
TOTAL
149. 15
REMARKS
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 Lie
FINAL DATE
INSPECTOR
Issued by:
Date 4A, —Permit,/ 1) �+
/L90.
Validated by:
/
Validation:
.tea
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
f
t 1 1
YARD SPKLR SYSTEM s'
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK'
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
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
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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
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 D
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 SIGNATURESIINITIALS
GARDEN WALL FINAL