9900 (RPL)Building 48-537 VIA ENCANTO
Address
Owner
RON NAWROCKI
Mailing
Address SAME
T4tyl � �Q�rw
P.O. BOX 1504
78-105 CALLE ESTADO �i
LA QUINTA, CALIFORNIA 92253 ! �'
City
Zip
Tel.
11 LA QUINTA,CA
92253
\564-4635
Contractor
OWNER%BUILDER
Address
BOX 5181 315
CityZip
Tel.: ,
LA QU INTA
Estimated Valuation
$500
State Lica
City
& Classif. C53 589960
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
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 l 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 rile a signed statement that he is licensed pursuant to
the provisions or the Contractor's License Law„Chapter 9 (commencing with Section 7000) o/
Division 3 o/ the -Business and Professions Code, or that. he is exempt therefrom, and -the basis
for the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for. a permit .
subjects the applicant to a civil penalty o/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 o/ property who,
builds or improves thereon and who does such work himself or through hisown employees,
provided that such improvements are not intended or offered /or sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
or proving that he did not build or Improve for the purpose o/ sale.)
O 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.).
❑ I am exempt under Sec. B. & P.C. for this reason
v.
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, EX M ION' FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 1/ the permit 'is for one hundred dollars (S100) valuation
or less.)
I certify that in the performance of tho 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
haws of California ,.
Date Ownerr:
NOTICE TO APPLICANT: If, after 'making this Certificate–df Exemption you should become
subject to the Workers' Co a r— 6`
Compensation provJsloris o/ the L7abor 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
ame
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 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
No. 9900
BUILDING: TYPE CONST. GASLINOCC: GRP.
A.P. Number
Legal Description
Project Description
50' 01F GAS LINE FOR SPA
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation
$500
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk.. Bal. ,
Const.
Mech.
Electrical
Plumbing
$15.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
4 K zw,"i iLl tis'P CZ ,(10 7 FJ
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:
.w
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
(ROUGH I]r
�J
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® Vic
HOUSE SEWER
REMARKS:
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 SEEPPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
(ROUGH I]r
�J
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. �/
1
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
i
FINISH GRADING
FINAL INSPECTION- l
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL