10008 (RPL)Building 44-270
Address :e*x1akk Villet
Owner
Mailing
Address same
T4ttt 4
P.O. BOX 1504 1' �N o. 10008
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. \� OCC: GRP.
City Zip Tel.
. LaQuinta 92253
Cont�ii
raed paal'a
Address
43580 Palmilila Circle
State Lic. I City
& Classif. , . _ _ _ _ _ Lic. #
Arcn., tngr.,
Designer
Address Tel.
City IZip I State
'j Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affi that I am licensed under provisions of -Chapter 9 (commencing with Section
1,7000) of.Div`ision 3 of the Business and Pl1rofessionstCode, and my license,is in full force and /
SIGNATURE DATE
OWMER-BUILDER DECLARATION,:
I hereby affirlm 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
permit to construct, atter, 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) of
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by,'any applicantfor 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 or property .who
builds or Improves thereon and who does such work himself or through his own. employees,
provided Nat such Improvements are not intended or offered for sale. If, however, the building
or improvement is said within one year of completion, the owner -builder will have the'burden
. of proving that he did not build or improve for the purpose of sale.) -
❑ I, as owner of the property, arm 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 or property -who builds or Improves thereon, and who contracts for
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
WORKERSCOMPENSATION DECLARATION
I hereby affirm that 1 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.)
Poly IN Company
Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be comrple.ed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the perfonnamce of the 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
aliforniaDateOwner
NOTICE TO APPLICANT: ff, afteA 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. '
y
`t
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 arplication 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
Number
Description
.t Description Pool and Spa
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:
Sq. Ft.
Size .. I
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
16,000
PERMIT
AMOUNT
Plan Chk. Dep....
Plan Chk. Bal.
•
Const.
171..00
Mech.
24.00
Electrical
45.00
Plumbing
27.00
S.M.I.
1.60
Grading
Driveway Enc.
Infrastructure
TOTAL
379. 7
REMARKS
p�'y r
tiS.i+`t;�Ji�'1"�"�
4TP
��''f'i•�#�3'.�`.�.�,'`»��.Y� i.J �
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
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
I L INSP � ��
G
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ILAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
i
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR @ V4c
HOUSE SEWER
LATHING
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.
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.Aw
I L INSP � ��
G
FRAMING
FINAL INSP.
ROOFING
REMARKS -
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL