09280 (RPL)Building
mailing
Address same
City Zip
La Quinta
Contractor
..Address
4,4
*1-1 P.O. BOX 1504
N o . 09280
78-105 CALLE ESTADO
Sevilla LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Tel.
Legal Description
Project Description
City Zip �2Tel.:
f�II - -14a-90
State OeCity
& Classif.. X53 185102 Lic. # 35
Arch., Engr.' "
Designer
Address Tel.
City Zip State
Lic. #.
r LICENSED CONTRACTOR'S DECLARATION
I he eby affigm th C I aro' licensedt niter provisions of Chapter 9 (commenc' g Jith Section
7000 of Division 3$i..ttie Businesed, Professions Code, and my license is)itn fdll force 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 cityorcounty 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) o/
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'five hundred dollars ($500).
O 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 thatsuch 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
o/ proving that he did not build or improve /or the purpose of sale.)
O I, asowner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044; Business and Professions Coder The Contractor's License Law
does not apply to an owner o/ property who builds or improves thereon, and who. contracts /or
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 Compensation Insurance, or a certified copylhereof. (Sec. 3800, Labor Code.)
Policy No. Company
/Copy is filed with the city. O Certified. copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ the permit is /or one hundred dollars ($100) valuation
or less.)
I certify that in the performance of lhg work for which this permit is issued, I shall not
employ any parson 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
Ihereby 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 it 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
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
13.000
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
AMOUNT
Infrastructure
TOTALOaUMW c+.�>ai:
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 Line
FINAL DATE
INSPECTOR
-"Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SD. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
ROUGH WIRING
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT.
GAS (ROUGH)3 --7_Rl 4b
WALL SO. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP/./n/ C
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
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1114 c
SEWAGE DISPOSAL
SPARK ARRESTOR
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 3
:p UNDERGROUND �00i'.'/up
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)3 --7_Rl 4b
METER LOOP
HEATING (FINAL)
OTHER APPJEGUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
// ry,
FINAL INSP. lJ t!l v[(<r
FRAMING
FINAL INSP/./n/ C
ROOFING
2__ r 5
. Ca
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
/ /]
FINAL INSPECTION ' LI
V
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
44 f
'BOB AND -JUDY POCHINI `
z ;; •' ' •"78.365 Highway 111,# 316
La Quinta, CA 922531981
00
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