15216 (RPL)_ P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address Ld0325 1iOlIia!:�s'in $ib'adm-s LA QUINTA, CALIFORNIA 92253
Owner
flip Lstrelli Co.
Mailing
Address
50--445 Hountain
Shadows
City
New ❑ Add ❑ Alter ❑ Repair ❑
Zips
Tel.
. ..La :
Quinta
92"a53
Contractor Me-Intyte roofs
1
a Spas
Address
'P.0. Box 1791
CityZip
La Quin'ta
92253
Plan Chk. Dep. -
Tel.:
State Lic.
$105.30
Const.
City
&•Classif...614611.
$ 2440
0
Electrical
Lic.# 1945
- Arch., Engr.,
nem,..".
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
4 7.000) of Div�s- -iY3 o Ike-Busin�J��'g/�nWProoff�essions�ode Fa�d_m_y license is in,full.for 'a d
ftect/,/ yf
'SIGNATURE 4 DATE
OWNER -BUILDER DECLARATION
1 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, 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 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 Ove hundred dollars ($500).
Cl. 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 fo 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.)
❑ 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
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 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.)
Policy No- Company
. ( dopy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(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 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.
Laws of California
Date ' Owner
NOTICE .TO APPLICANT. N, 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 pemrit shag 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.
1 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
ateMailing Address
City, State, Zip
No. 15216
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description 2001 At SPA
Sq. Ft. No. No. Dw. .
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑
Demolition ❑
Estimated. Valuation
PERMIT'
AMOUNT
Plan Chk. Dep. -
Plan Chk. Bal.
$105.30
Const.
$162-.00
Mech.
$ 2440
0
Electrical
$ 45.00
Plumbing
23, 00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
$363.30
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 Prop�?L ni elll
FINAL DATE INSPECY R
Issued -by: Date / ✓Permit
.Validated by:
Validation:
• V
CONSTRUCTION ESTIMATE
NO. ELECTRiGAt FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. Ff. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM • s
BAR SINK y
ROOF DRAINS i
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROUGH WIRING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
DUCT WORK
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
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 % c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
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 APP./EQUIP.
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
n
r
Y�
L—p
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
.INAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESHNITIALS
GARDEN WALL FINAL