14053 (SFD)Builcing
Address 48-212 Vista be
T-ihf 4- 4 Q9bA
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Q fn1bger Snellenberger 4 ASSOCi.ateS I
Address 55-695 Pebble Beach
1
City Zip Tel.
L4 Quinta, CA 92253 1(619)777-7767
wont -actor
Slime
Address .
State Lie. City
& ClEssif..g 480234 Lie. # 1858
L Desi ergr 'Car .
� os Elias Engineer
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A.3 Is5 Charlesworth Dr. N19) 328-7271
CityState
Cathedral City Zip CA 922314 Lie. #
LICENSED CONTRAOTOR'S,DECL'ARATION
I heneby affirm,tfiat I am licensed under provisions o6(5 apter9 (commencing with Section
7000) of Division 3pp"of the Business and,P ofessions,Code, and my license'is in full force and
SIGNA'URE DATI
11 OWNER -BUILDER DECLARATIUk
I ieereby� ffirm that I am exempt from the Contractor's License Law for the following
reasor_%V(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'pr:+visions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Divfsio,, 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for i 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 ($500).
❑ 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
Profes-.fons 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,
proyided that such improvements are not intended or offered for sale. If, however, the building
or img ovemenl 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-
slructi the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does aot 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:) -
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❑ 1 am exempt under Sec. B. & P.C. for this reason
1'
Date Owner
j 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.)-
Polici No. Company
❑; Copy is filed with the city. 0 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 ($100) valuation
or les;.)
I I zertify that in the performance of thg 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
LaWsof California.
Date Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
compry with such provisions or this permit shall be deemed revoked.
I
CONSTRUCTION LENDING AGENCY
I'iereby affirm that there is a construction lending agency for the performance of the
work br which this permit is issued. (Sec. 3097, Civil Code.)
LendF's Name
Lender's Address
Jh-s 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 ce tify that I have read this application and state that the above information is correct.
I agrees to comply with all city and county ordinances and slate laws relating to building
const -action, and hereby authorize representatives -of this city to' enter the above-.
mentioned property for inspection purposes.
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Signa'ure of applicant Date
Mailing Address
City, State, Zip
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No. 3.4053
BUILDING: TYPE CONST. OCC: GRP R3
A.P. Number 646-110-016
Legal Description Lot 10 Tract 20052-7
Project Description SP'ID Plan 4
Laguna tie La Paz
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:
r
Sq. Ft.
Size 1562
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$90t137.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
513.10
Const.
599.00
Mech.
62.00
Electrical
127.25
Plumbing
15.0.00
S.M.I.
9.10_
Grading
20„00
Driveway Enc.
.00
Infrastructure
2;028.08
TOTAL
3,508.53
REMARKS
...,.
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. FT. ® $
UNITS
SLAB GRADE
iSO.
r
ROUGH PLUMB. BONDING
HEATING (ROUGH)
2ND FL. SQ. FT. @
FORMS
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN,
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
u
O +0 IN 0
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/e c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 A ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIN 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)/ / L METER LOOP
7107
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL 911V
GAS (FINAL)
1(OP TEMP. POLE
1
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. /
FRAMING
FINAL INSP.
ROOFING`j
VENTILATION t
u
O +0 IN 0
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND �! Z
FINISH GRADING
FINAL INSPECTION / l
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL