10387 (PAT)Building
Address 78-360 VIA
Owner
DRAKE LARSON :.
Mailing
Address SAME
City Zip
. to QUINTA
Contractor
OWNER BUILDER
Address
SAME
� a
P.O. BOX 1504 " ' ~ N o . 10387
SEVILLA LA QUINTA CALIFORNIA 92253..• A,
e
360-5409
City Zip Tel.:
LA QUIRTA SAME
State Lic. City
& Classif. Lic. #
Arcn., tngr.,
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 I am exempt from theContractor's License Law for the following
reason: (Sec. 7031.5,Business -and Professions Code:, Any city or county which requires a
permit to construct, after,?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 of 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 of Section : 7031.5 .by any applicant for a permit
subjects the applicant We civil penalty of not more than rive hundred dollars.(5500).
I; as owner of the property, or my employees with wages as their sole compensation, will
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
• ti ' 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. 11, 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 o/ sale.)
;�:F 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.)
O 1 am exempt under Sec. B. &'.P.C. for this reason
'Date f d Owner r
. 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 EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is, for one hundred dollars (5100) 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 so s" to become subject to the Workers' Compensation
Lawstof California. 7- / ,✓'
er
NOTICE TO APPLICANT: If, alter making this Certificate o/ 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
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
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Legal Description
Project Description
Sq. Ft. 470 No.
Size Stories
No. Dw.
Units
New ❑. Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation $6,100
PERMIT
AMOUNT
Plan Chk.=Dep.
Plan Chk- Bal.
$58.50
Const.
90.00
Mech.
Electrical
Plumbing
S.M.I.
.80
Grading
Driveway Enc.
Infrastructure
TOTAL 5
REMARKS
Ufih r- r .-v•t
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. SQ. FT. ® $
UNITS
SLAB GRADE l
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING `
CAR P. SQ. FT. ®
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
PO LE,TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11% c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR ® 3yc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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 l
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSUY
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
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