14726 (PAT)Building .48-604 Vista ".Sierra
Address
Owner t�laarla Ka uteri
Mailing
Address Sale
City Zip Tel.
La. Quints * 92253.
K.T.
/Contracto►ronpj. rwtoW '
.Address .
78-2&1 Border;!
City Zip r Tel.:
�eIMuda Dunes C� 9bs201 56
State Lic. City
& Classif.. ,$ 421915 • Lic. #
Arch:, Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
44 uullttc� .
P.O. BOX 1504 No. 14726
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4-2176
1484
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description +atio Cover
Verbal. approval received from Ron
?jerkins, Laguna De La Paz H.Q•.A4
Sq. Ft. No. No. Dw.
Size •360. • . Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
I hereby affir-Ithaf I am licensed under provisions of Chapter 9 (commencing with Section
7*) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE *T••- " '—" DATE _ -
' OWNER- UILDER DECLARATION
I. -
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
reason: (Sec: 7031.5,Business •and Professions Code: Any, city, or,county which requires a .
S.M.I. .
permit to construct,' alter, Improve, demolish, or repair any structure, prior to its .issuance also
Driveway Enc.
requires the applicant for.such permit to file a signed statement that he is licensed pursuant to
. PERMIT'
the provisions of the Contractor's license Law, Chapter 9 (commencing with Section 7000) of
WORKERS' COMPENSATION DECLARATION
I hereby affirm that'I have a certificate of consent to self -insure, or 'a certificate of
Workers Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company '
O Copy Is filed with the city. ❑ Certified copy is.hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE,
(This section need not be completed if the permit Is for one hundred„dollars ($100) valuation -
' or less.)
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, ^and the basis
'
Dep...
for the alleged exemption. Any violation of Section 7031.5 .by 'any applicant for a permit
Plan Chk. -
subjects the applicant to a civitpenalfy of not more than five hundred dollars ($500). •
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
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 bnprovements are not Intended or offered for sale If however the b—Mln
Mech..;'
g.
or Improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or inprove.for the purpose of sale.) ..
❑ 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 contractors) licensed pursuant•to the Contractor's License Law.)
❑ t am -exempt under Sec B. & P.C. for this reason
Electrical
Plumbing
S.M.I. .
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that'I have a certificate of consent to self -insure, or 'a certificate of
Workers Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company '
O Copy Is filed with the city. ❑ Certified copy is.hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE,
(This section need not be completed if the permit Is for one hundred„dollars ($100) valuation -
' or less.)
TOTAL
REMARKS -
AMOUNT.
4.5.80
72.00
48
I certify that in the performance of>thp work for which this permitris issued; I shall not
mployany pperson in any mannereso'as,to become subject to thelWorkers' Compensation
ws'of Califoinia<
Date” Y �' f:iOwner ,f �„''�'e'�`^'°" '^+'^..--•^��'` Lf...�ioLY.,..+r'
NOTICE TO , APPLICANT: ff, after making this Certificate o/ • Exemption you should become ZONE: BY: '
subjeet to the Workers' Compensation provisions or the• Labor Code, you must forthwith
comply with such provisions or.thla permit shall be deemed revoked. Minimum Setback Distances:
1 Front Setback from Center Line
Rear Setback from Rear Prop. 'Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, ANDSide Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES:UP.TO.ONE •
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,' — Side Setback from Property .Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ' /r
ATTORNEY'S FEES. / �1111
This buil
is a ding permit when property filled out, signed and validated, and is subject toFINAL -DATE
expiration it work thereunder is suspended for 160 days.
��.
_ I certify that I have read this application and state that the above information is correct.- :1 Issue'd"t5y'
I agree to comply with all city and county ordinances and state laws relating to building 1 � tJ 1. J -71a .r
construction, and hereby authorize representatives .sof this city to enter the -above
mentioned property for inspection purposes: Validated by:,,
C. ...".
Signature of applicant Date
Mailing Address .Va1idatiorx
City, State, Zip
it
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
FOR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SO. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Va c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
n
FRAMING ') 2 1
FINAL INSP.
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 SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.MI7/7
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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.
n
FRAMING ') 2 1
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION V
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL