11054 (RPL)4
P.O. BOX 1504 N o . 11054
Building78-900 V lleta Dr 7&105 CALLE ESTADO
AddresLA QUINTA, CALIFORNIA 92253
Owner
Mr f mr s liurj a
Mailing .?" BUILDING: TYPE CONST. OCC: GRP:
Address S"tie as �3brve
A.P. Number
City La Quinta zip3�253 T
1.346-60s5
Legal Description
ContRactoC� Pcti�3.sl5�C� Project Description'
T��.
Address Pool and-Spa
P. 0. aBox 897
City Zip Tel,:
P.S. 92263 327--:080
State Lic. City
& Classif. C53 C8 472.334 Lic. # 971 Sq. Ft. No. No. Dw.
Arch., Engr.; -
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ . Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed underprovisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and.Profeasions Code, and ,my license is in full force and
effect.
SIGNATURE •� """ ,�- _ , If - DATE 1•
!{ OWNER-BUILDEN ECLARATtVN Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated
reason: (Sec. 7031.5,Bustness and Professions Code: Any city or county which requires a 15,000
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also '
requires the applicant for such permit to we a signed statement that heis licensed pursuant to - PERMIT - AMOUNT
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 o1 Section 7031.5 by 'any applicant for a permitPlan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O I, as owner A the property, or my employees with wages as their solecompensation, will . Plan Chk. Bal. 105 • 30
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 16 2 00
Professions. Code: The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon and who does such work himself or through his own employees, Mech. f
provided that such improvements are not intended or offered for sale. 11, however, the building �2 4 • 00
or improvement is sold within one year of completion, the owner-builder will have the burden Electrical < @ 5 . Q 0
of_proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con, Plumbing • 217 • 00
Strutt the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property:who builds or Improves thereon, and who contracts for S.M.I: I • 50
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O I am exempt under Sec B- 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby/affirm that I have a certificate of consent to self-insure, or a certificate of
Worker's1C6mpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
P61icy.M. .Company
,,''Copy is filed with the city. ❑ Certified copy is hereby.furnished.
TOTAL -3-64. 0,0
CERTIFICATE OF EXEMPTION FROMREMARKS firf
WORKERS' COMPENSATION' INSURANCE..
(This section need not be completed ff the permit is for one hundred dollars ($ 100) . valuation
or less.) Y
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in an manner so as-to become subject to the Workers"Compensation
Laws of California® f ,
Date Owner
NOTICE TO APPLICANT: Nafter making this Certificate of Exemption you fshoLld become ZONE: BY:
subject to the Workers' 'Corrmpensationj'provisions -o1 the Lab&r. ode• you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. '
t` Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, CWI Code.) Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when property filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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. Issued by: Date Permit
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- Validated by:
Signature of applicant Date
Mailing Address _ _ Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SO. FT. ®
SQ. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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.
SO. FT. ® c
BATH TUB
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® 414c
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
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.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
-
V r
///
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I NSU LATIONISOU N D
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL