9705 (RPL)Building X
Address 52-010 Montezuma
.
Owner
Oemeral. Con8tructa.on 14
Mailing
Address
City Zip
..La 'QuInta 92253
Contractor
C*.J.'s iotalc
Address
52-995 Mwindoza
City - . zip
La 0ii-Irta
• •. State,Lic.
'&Ciassif. C53 -590746
'`Arch., Engr.,
s Designer
.y • , �
P.O. BOX 1'504 N o . 9705
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 •
BUILDING: TYPE CONST: OCC: GRP..,
A.P. Number
Tel.
Legal Description
Project Description
Tel.:
564
City
POOL ONLY •.
w
1658 Sq. Ft. • No.. No. Dw.
Size Stories Units
New O Add ❑ Alter O Repair•0
-Demolition O
Address
Tel.
City
Zip
State
Lic. # -
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that Lam licensed underprovisions of Chapter 9 (commencing with Section
QW of Division 3 ofythe Business and Professions Code, license in full
f• .•
and my is force and
eit@dt..
—
.. .
1; }_SIGNATURE. `. _" .' -.- DATE
" OWNER -BUILDER DECLARATION -
Thereby 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
Estimated Valuation
7 90
'
PERMIT AMOUNT - ' . • -
'
permit to construct, alter, improve, demolish„or repair any structure, prior to its issuance also
requires the applicantfor 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.($500).
D -I, as owner of theroe
p p rty, or my employees with wages as their sate compensation, will,
w Plan Chk. Dep. -
Plan Chk. Bal.
Const. .r 99.00 s
do the work; and the structure isnot 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
' Mech. - • ¢ . 4
.builds or improves thereon and. who does such work himself or through his own employees,
. provided that such bnprovements .are. not intended or offered for sale. If, however,. the building.
_
Electrical. - �;Q`�
,,
or improvement is sold within one.year of completion, the owner-builderwill have the burden
Of proving that he did not build or improve for the purpose of sale.) .. -
Plumbing `x ,'. 00
-
O 1, 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 property -who builds or improves thereon, and who contracts for
.. •-
- .S.M.L . • : 80.
such projects with a contractor(s) licensed pursuant to the.Contractor's License Law.) _-
D I am exempt under Sec- B. & P.C. for this reason
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION 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.).
-- - _
' Policy No ;Company
D Copy is filed with the city. D.Certified copy is hereby furnished:
t, 4 n ' CF v ifs "b "
yi^s 4t'�. ' (ti�v `ht?a'�0` Yrr? t ; r -
TOTAL 239015 .
- CERTIFICATE OF EXEMPTION FROM
- WORKERS'. COMPENSATION INSURANCE . .
REMARKS
- --• -
(This section need not -be completed ff 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 ihany anner so as to become subject to the Workers' Compensation"
Laws of California
Date' Owner
NOTICE TO APPLICANT: ff;lalter 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.
..r
ZONE: BY: - -.
Minimum Setback Distances`. - •M•�
Front.Setback from Center Line
Rear•Setback from.RearProp. Line
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.)
Side Street Setback from Center Line '
- Slde. Setback from.Property Line' '
Lender's Name
Lender's Address
FINAL DATE INSPECTOR
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 1 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. t
Issued by: Date Permit-,
I. Validated by: '•
Signature of applicant' Date
' Mailing•Address '
Validation: - -
,.City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
190OF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 844c
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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
�J�
r^ 7/2 t0`
alo IFI
/P/
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