9709 (BLCK)P.O. BOX 1504 N o .
Building78-34th iIA S$VILLIA 78-105
Address LA QUINTA, CALIFORNIA 92253
BOB RICRIE
Address SAME
CityZip Tel.
LA QUINTA.CE 92253
Contractor
PARAGON BUILDERS
Address _
49-125 TA14GO CT.
CityZip Tel.:
.A QUIDITA,C 92253 564-2969
& Classif. $ . C-20 455121 I Lic. # 18112
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am Iicenseli under provisions of Chapter 9 (commencing with Sgction ,
7000) of'Division 9 o� Busihess and Professions Code, and my license`ia inffu Il#or e a d
ffect.'`a i �—
S
MATURE "4 ""'"S'�..ti --'— DATE
OWNER -BUILDER DECLARATION /
I hereby affirm that I am exempt from the Contr gpr's License Law fir the following
reason: (Sec. 7031.5,Business and Professions Code: Any1clty or county which requires a
permit to construct, alter, improve, demolish, of iepai�any sfrr?cy'ture, prior to its issuance also
requires the applicant for such permit to file.a signed it'aiiymen 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 or not more than five hundred dollers.($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 or completion, the owner -budder. will have the burden
of proving that he did not build or improve for the purpose or sale:)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
strucl 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.) -
0. 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 co�yA�e e�o'f. (Sgc ft,eor Code.)
' I' No. P Company ufftfi +fIl SrAt�Llri
tt dopy 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 (S100) 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 subject to the Workers' Compensation
Laws of California.
Date 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
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
expirationit 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
BUILDING: TYPE CONST. BLOCK W66,0+GRP
A.P. Number
9709
Legal Description
Project Description BLOCK MALL: 301 8 6'
REMARKS
005182 10 10
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 bv:
Validation:
60V R 2;
Sq. Ft.
Size
No. No. Dw.
Stories Units .
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
r
Estimated Valuation .
$750 (for 6 • wall)
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
$25.00
Mech.
Electrical
Plumbing
S. M.I.
•
Grading
Driveway Enc.
Infrastructure
TOTAL
•
REMARKS
005182 10 10
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 bv:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
2ND FL. SO. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
HEATING (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN.
SO FT ®
DUCT WORK
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
HEATING (FINAL)
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
FINAL INSP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
Q
v
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. Fr. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FIRE ZONE ROOFING:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE 714ST.
FEE ELECT. FEE
SMI FEE 7T7FEE
STRUCTURE /PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
01
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
Q
v
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION ( /
l
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL