06550 (RPL)7via (arnd0 P.O. BOX 1504
Building .67.►orri Cda 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Josia Lavenda
Mailing
Address Sane
City I Zip Tel.
Contractor
Ilools by Carmine
Address
Palm Desert 42260 346-6335
State Lie- City
& Classif- 52043_2 Lie. # 1366
Arch-, Engr.,
Designer
Address Tel.
City Zip State
Lie. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under ptovislons oI Chapter 9 (commencing with Section
TOpOt of Division 3 of the Business and Professions Cod&, and my license is In full Force-arjd
efTecl.
. F
SMNATll E _ _ _ _ '- +� STATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec 7031-5,Bminess and Prolessims Code: Any city or .county which requires a
pemtif to construct, aher. Im4arove, demolish, or repair any structure, prior to its lssuxwe also
requhros the applkanl for such pomrif 10 rile a signed sfaloment that he A dcensed pursuant to
(he prrndslorrs of the Contractor's Lkense taw, Chanter 9 (commericing wilh Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and rho basis
for the alleged exempban. Any vkAabri of Section 7031.5 by any appllcanr far a permif
subjects the aPPEca,nt to a cK* penalty of nut more than 8vo hundred dagars f$500J.
L7 1, as owner of the properly, or my employees with wages as their sale compensation, w I I I
do the work, and the structure is not intended or offered For sale. (Sec. 7044, Bussness and
Prolesshm Code-- The Cantracrors License Law does not apply to an owner of property who
builds or improves thereovr and vdin does such work hinsetf or through his awn employees,
provided that such knprov ements are nor Intended or offered for sate. tf, however, the bulldxtg
OF improvement Is add within one year of cornplerien, the owner-bufder wA have the burden
of proving lhaf he did nal WN or improve for the purpose at sate.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec- 7044, Bbskhuss and Professions Cade: The Conlraclors License Law
does not apply to an owner of property who bulls or improves thereon, and who contracts for
such projects with a confraclor(sJ rrcenied pursuant le the Contractor's License Law.)
❑ 1 am exempt under Sec-B. R P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificale of consent to self -insure, or a certillcate of
Worker's Compensation Insurance, ora certified copy thereof. ISec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ 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 lass.)
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.
[late -Owner
NOTICE TO APPLICANP If after making 1149 Cortilkale of Exemplrba you should became
subject ID the workers' C0114wi rsatlon provisions of the Labor Code, you must forthwith
comply with such provaforis or this pomvr shaft be deemed revoked.
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, Ovil Code.)
Lender's Name
Lenders Address
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 Hof this city to enter the above -
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Ni 06550
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number T'STG La ('Nuiy
Legal Description
Project Description =001
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
81.90
Const.
126.00
Mech.
30.00
Electrical
27.00
Plumbing
24.3?
S.M.I-
.7
Grading
Driveway Enc.
Infrastructure
TOTAL
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
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT ®
SO. FT.
SO. FT.
SO. FT. ®
SQ. FT.
SO. FT. @
SO. FT. @
VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
I
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
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 APP.IEQUIP.
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
% r
f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
I N S RECTO R' S S IG NATU RE 571 N IT IALS
GARDEN WALL FINAL