10524 (RPL)4 Ov
'- 524
.
P.O. BOX 1504 No10
� (�
78-105 CALLE ESTADO
Address 50-915 15 CALLE POL-OMA LA QUINTA, CALIFORNIA 92253 ,/` f C
Owner I
A & H COESTRUCT101;
Mailing
Address P G BOX 466
City Zip Tel.
Le QUINTA 192253 1 564-4432
Contractor
A & M CONSTRUCTION
Address
P 0 BOX 366
City Zip Tel:
LA QUINTA 564-4832
State Lic. City
& Classif. C 53_614611 Lic. # 626
Arch„ Engr.,
Designer
Address Tel.
CityI Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provlslons of Chapter 9 (commencing with Section
"eeffec
.M t.c€ Division 3 of the Business and,Professions Code, and my license is in full force and
310 -NATURE_ oF�EE
OWNER -BUILDER DECLARATION
I 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, alter, improve, demolish, or repair any structure, prlor.lo its issuance also
requires rhe applicant for such parmrT to life a signed stWarnenf that he Is ilcensed pursuant to
the provisions of the Contractors License Law, Chepler 9 (commencing with Section 70001 of
Clvision 3 of the Business and Prolesslons Code. or fhei 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 penally of not more than five hundred dollars ($500)-
0 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
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or #rrproves 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 wtthin 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 conir,wling with licensed contractors to con-
struct the project. (Sec. 7044, Business and PaJesstuns 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I horeby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers CDmpensarien InstLranca, or a certified copy thereof. (Sea 3800, Labor Code.)
. Policy NO.. - Company
L•3 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 hurrdrsd dollars (5100) valuation
or fess.)
I certify that In the performance of the work for which thls permit Is Issued, t shall not
employ any person In any manner so as to become subject to the workers' Compensation
California
Laws of
DateOwner
NOTICE TO APPLICANT., If, eller making this Certilieate 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 shail 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, Civil Code.)
Lender's Name
Lender's 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 appiieation and state that the above infwrmatlon is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorlxe representallves sof this City to enter the above-
mentioned property forinspsctlon purposes_
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description SWIMMING Pool
Sq. Ft.
Size
No.
Stories
No. Dw-
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
912,000
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
a7 75
Const.
235.00
Mech.
'14.00
Electrical
45.00
Plumbing
27.00
S.M.I.
1, 20
Grading
Driveway Enc.
Infrastructure
TOTAL
y3
9 . 9 5
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:
A CONSTRUCTION ESTIMATE
7
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL. SO FT. ® _
POR. SQ. FT. ®
GAR. SO. FT. ®_
CAR P. SO. FT. ®
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION
$ UNITS
%
A.C. UNIT
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
HEATING (ROUGH)
DRINKING FOUNTAIN
FORMS
URINAL
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FOUND. REINF.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
HEATING (FINAL)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
WATER SYSTEM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
_$
SQ.FT.GAR ® 34c
HOUSE SEWER
FINAL INSP. !l u',
FRAMING
Jam/
FINAL INSP. Il /C
t L /
GAS PIPING
PERMIT FEE
g
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 S AIR COND. SOLAR
SETBACK
/ ROUND PLUMBING
UNDERGROUNDS
%
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. !l u',
FRAMING
Jam/
FINAL INSP. Il /C
t L /
ROOFING
g
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
r
FINAL INSPECTION .�1;
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITfALS
GARDEN WALL FINAL