14689 (BLCK)4
P.O. BOX 1504
Building 78-495 CALLE _ 53-700 -Ave. MontezT3I a LA QU NTA, CALIFORNIA 9
Address 2253
Owner Santa Fe Homes
faamng
Address P.O. BOX 4iC
CityZip Tel.
La Quinta, CA 92253 564--1866
Contractor
Lendel Ventures
!.. 77
City Zip
StateState Lic.
& Classif. B 638525
Arch., Engr.,
Designer
Address
City lZip
Lic. # 859
Tel.
State
Lic. #
LICENSED;CONTRACTOR'S DECLARATION
hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
DO),of Division 3 of the Business and Professions Code, and my license is in full force and
ect. Gs I. t-,Y'f °ffr•f.�l'�L6``e��.r/.iJe� _ . ,.y.� 2r -"%r•
OWNER -BUILDER OECLARATI9,N-
I hereby affirm that'I' am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5;136siness and Professions Code: Any city or county which requires a
permit to construct, cher, Improve, demolish, or repair My structure, prior to its issuance also
requires the applicant±for such permit to file a signed �9"tatement that he is licensed pursuant to
the provisions of he Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the'BBusiness and Professions Code, orjthat.he is exempt therefrom, and the basis
for the allegeffjexemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civi penalty of not more than five hundred dollars ($500).
O 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 o/ 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
or Improvement is sold within one year o/ completion, the owner -builder will have the burden
of proving that he did not build or inprove for the purpose o/ sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. fSec. 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.)
O 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby,, affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker's — pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy. company
1Copy is filed with the city. ❑ Certified copy is hereby furnished.
vv CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) 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., d, after making chis 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. '
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND
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,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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 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
No. 14689
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description 40' of 5' high, and 361 of
4' high garden block wall
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $1,526.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. 45.00
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL 45.00
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 I—Permit
'!n L
—.
n
Validated by:
,
Validation:
C n/1.
r,
sy
I
-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. @ $
2ND FL. SO. FT. @
POR. SO. FT. @
GAR. SO. FT. @
CARP. S0: FT. @
WALL SO. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR . SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11A c
SEWAGE DISPOSAL
� � l _
SO.FT.GAR @ 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MEC 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 APPJEOUIP.
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
� � l _
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FFNrF FINAI
GARDEN WALL FINAL
I
INSPECTOR'S SIGNATURESIIINITIALS