9457 (RPL)P.O. BOX 1504 ^t#�+. C f ' 0. 945T Y
Building 78-105 CALLE ESTADO r,
Address .78-725 VAA elodia • -' LA QUINTA„CALIFORNIA 92253
Owner ��
Anthonya Wanda Matrl:anga BUILDING: TYPE CONST: • ` OCC: GRP. `
Mailj_ng
Address. I&M-3
A.P. Number
City Zip Tel.
La i.rata 92253. 564-•'4198 Legal Description
Contractor Project Description Pool only
f3vrneZ'/Bu lder.
Address
City' Zip Tel::
State Lic. City ;
& Classif. Lic. # Sq. Ft.' No. No. Dw.
Size Stories Units A
Arch.,- Engr.,
Designer New 0 Add' 0 Alter 0 Repair 0 -Demolition 0
,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.
r
SIGNATURE - DATE - .y
OWNER•BUILDERDECLARATION.. Estimated Valuation.
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 _,5F800.00 1
permit to construct, alter, Improve, demolish, or repair .any structure, prior to its issuance also
requires the'appficant for such permit to rde.a signed statement.that.he is licensed pursuant to : .PERMIT`• AMOUNT,
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of - ' • + '
. Dlvlslon 3 of the Business and, Protessions ' Code, or that: he is exempt therefrom; and the basis
for 3the alleged 'exemption.. Any �vfolatlont'of. Section 7031.5 by. 'any.•applicant-for a'permit ..Plan Chk. Dep. •,. '.�
•'subjects the applicant to a civil penalty of not more than five hundred dollars (S500).
Plan. Chk. ,Bal.
�, • I, as owner of the property, or my employees with wages as their sole compensation, will 52 • 5 5
•.do the work, and the structure isnot intended or offered for sale.`(Sec. 7044, eoisness•and I t
Professions Code: The- Contractor's License Law does not .,.Plan,
_ .. 81' �1�
c+ apply_to �an,owner p/'property who •
,•I�i builtls or Improves thereon •and I who does such work himself or -through his own employees, - -
Mech. 24 60
„.�.provlded that such Improvements are not Intended or offered. for sale. -fQ however,•Ne building.' �- ''- - - w •
or-lrriprovement is sold within , one year, cf completion,. the owner -budder - will have . the burden Electrical
provlrig that he did not. build or improve for the purpose of sale.)
ob
as owner of'the property, am exclusively contracting with licensed contractors to con- . Plumbing r-• Q Q
r ., struct.tha project. (Sec. 7044, Business and Professions Code: The Contractor's. License .Law -27
_ °does not apply to an owner of property who builds or.improves thereon, and who contracts. for S. M. 1. •(.2
_ such projects with a.contractor(s) licensed pursuant.to the Contractor's License Law.)
Grading'
' ❑ I am exempt under Sec. -� � B. &.P:C. for this reason •- - -- .. .
Driveway Enc.
Date Owner. 1f 7` s� i :{i' = `.'tom.. 'Infrastructure
WORKERS' COMPENSATION DECLARATION ,•> ,
Thereby affirm that 'I have a certificate of consent to self -insure, or a'certificate.of - t,
Worker's Compensation Insurance, ore certified copy thereof. (Sec'. 3800, Labor Code:)
Policy No. .Company . t ,
%Copy Is filed with the city. 0 Certified copy is hereby furnished.
TOTAL 230.07 >a
CERTIFICATE OF EXEMPTION FROM' REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundre5'dofiars.($100) valuation
or less.) i
J I certify that In the performance of thg work for which this permit is issued, 1 shall not s
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. t
Date Owner
NOTICE TO APPLICANT: If,aftermaking this Certificate . or Exemption you should become 'ZONE:BY:
'subject to the Workers' Compensation provisions olathe. Labor 'Code, you must forthwith •_i `'•, '
. comply withMinimum SetbackDistances:
'such provisions or this permit shall be deemed revoked.
- Front Setback from Center Line
Rear Setback from Rear Prop. Line
` CONSTRUCTION LENDING AGENCY' Side Street Setback from Center Line
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.) - Side Setback. from Property Line
Lender's Name ,
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject'to' FINAL DATE INSPECTOR
expiration It work thereunder is suspended for 180 days. .
I certify that I have read thisapplication.and state that the above information is correct. Issued by: _ ' f Date Permit
I agree to comply with all -city and countyordinances and state laws relating to building '
construction, and hereby authorize representatives -of this city to enter the above-. ,
mentioned property. for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip • + t
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT, ®
CAR P. Q. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION t $
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
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)/-///?/-,, METER LOOP
111
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
RMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
MAMPERES
LAVATORY
HEATING SYSTEM. FORCED GRAVITY
RV ENT
SHOWER
BOILER.B.T.U.
SO. FT. ® c
BATH TUB
FRAMING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.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 9/fA11,0 UNDERGROUND
CGI�G
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
111
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. �'<n
FINAL INSP 2•? 7(
a[�
q l C
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FRAMING
ROOFING
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION[
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL