14175 (RPL)'4
.`g. P.O. BOX 1504
Building 44.340 Viileta 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Hill
Y
Address Same
City Zip Tel.
La .Qua;nta, CA 92253 3.60--8854
Add
AVS-. all3�.i'f'Z
Cit Quinta, CA zip 92253 Tel 655
State Lie.City
& Classif. C531,658996 Lie. # 2893
,Arch:,-Engr _ _
Designer
Address - Tel.
City Zip State
Lie. #
ICENSED CONTRACTOR'S DECLARATION
I hereby aff rmItha I am licensed under provisions of Chapter 9 (commencing wit Sf
A 00) of Divislc�Wof.the.Business and Professions Code, and my license is in full fore
%% OWNER -BUILDER DECLARATION t
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 city or county 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) 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 of not more than five hundred dollars (8500).
❑ 1, 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
orimprovement 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 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 propertywho,builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
❑.I 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 Corgpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
PolicyJ. Company
El 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 (8100) 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 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
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
BUILDING: TYPE CONST.
No. 14175
OCC: GRP.
A.P. Number
z
Legal Description
Project Description pooh a d 'Spa
Sq. Ft. No. No. Dw.
Size • Stories Units
New ❑ Add 0 Alter O Repair ❑ Demolition
ZONE: BY:
Minimum Setback Distances: fu
Front Setback from,Cener Line 4:a
Rear Setback from Rearlft�
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
t.
Estimated Valuation
$14 a 600. 00
PERMIT
AMOUNT
Plan Chk. Dep.
R`y
Plan Chk. Bal.
10 .30 4.
Const.
16e * 00
Mech.
Z4.'00
Electrical
45.,00
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
.
TOTAL
•� ''
REMARKS
ZONE: BY:
Minimum Setback Distances: fu
Front Setback from,Cener Line 4:a
Rear Setback from Rearlft�
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 t`
A.C. UNIT
COLL. AREA
SLAB GRADE
1ST FL.SO. FT. $
UNITS
i
HEATING (ROUGH)
STORAGE TANK
FORMS
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
FOR. SQ, FT. ®
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GROUT
WATER HEATER
SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SO. FT. ®
WATER SYSTEM
WALL SQ. FT. ®
-$
DRINKING FOUNTAIN
FINAL INSP.
URINAL
SQ FT ®
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
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
POLE, TEM/PERM
LAVATORY
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FENCE FINAL
GAS PIPING
PERMIT FEE
INSPECTOR'S SIGNATURESIINITIALS
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
i
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
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.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
( /y
I�
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
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Nk
V
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POOL AREA TO BE ENCLOSED BY
MINIMUM 5 FT. HIGH FENCE.
ALL GATES TO BE SELF-CLOSING r
AND SELF -LATCHING.
CITE F LA QUIN"A..
BUILDING � ��.�����' DEI -Y I~�,7���I���T ,
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