15785 (BLCK)P.O.-BOX 1504 .15785-
!Bt(llding' 78-495 CALLE TAMPICO
Address 77-750 50th Ave LA QUINTA, CALIFORNIA 92253
Owner` La Quinta Country Club
Mailing BUILDING: -TYPE CONST: OCC: GRP.
Address -,Sable A.P. Number
City Zip Tel.
CAI 92253 Legal Description
e ' bri".
Contractor of 4�T tPR� 1Q i l store. front
RU111t1�%I COa�stst�ction Project Description : , • •
Cut in dauamle ehtry doors. Repair.wall -
A ie 4 n s ode.. framing In card ro ms to original.
Cif . Zip reli
Fat:�edral Ci:t r ; CA 9223414:-7929
State Lic. City t'
& Classif..$.. 416304' Lic. # .. 3819 Sq. Ft. No '. No. Dw. _
Arch Engr.; Size Stories Units `
•De's'igner 1 .'Crai4 Pearson. New ❑ Add D Alter ❑ Repair❑ Demolitidr'El
AJb25So
53'r4Wr�l�C Tel.
City Zip State
Palm. :t e�ier:tj, .A 922g5 Lic. #
_LICENSED CONTRACTOR'S DECLARA710N 3 t
I hereby affirm that I am licensed under Drgvislo of r 9 Chpp e(—commencing with Section 1.
7000) of Dw%i'siow1of the B siness and'ProfasAss'p'n'sCiiV0L:and-my-llcense 1s in full force and /
-. effect Y +Y�`f '/ ...6 �'1 =d, a r---�'✓ . +
r �LGNATURE- - f DATE
OWNER -BUILDER DECLARATION Estimated ValUatlOn ay t� 000.00
�qrt/.���ff f/��f�
I hereby affirm that I am exempt from the Contractors License Law for the following �b'6i a/tJ it • ti�
reason: (Sec. `703 1.5, 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.
AMOUNT '
requires the. applicant. (or'such permft to file a'slgned statement that he Is licensed.pursuant to � PERMIT " .f.
the provisions o/ the' Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Cade, or that. he is exempt therefrom, and the basis - '+ -
for the ails ed 'exemption., An violation o/ Section 7031.5 by. 'an permit Plan Chk. De g mp y. y applicant for a p C3
subjects the applicant to a cmi penalty of nor more than rive hundred dollars ($500). - .Plan Chk. Bal. - 122 e v
❑ I, as ownet: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 p�l A
Professions Code: The, Contractor's License Law does not apply to an owner o/ property who Const. 16?!
builds or improves thereon. and who does such work himself or through his,own employees,
,provided that such'improvelrients are not Intended or offered 'for sale. 1/, however, the building Mech.
or improvement-- is'sold within -one year o/ completion, the owner -builder will have the - burden •
of proving that He did not build or Improve for the purpose o/ sale.) Electrical
of, as owner, of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project..(Seca. 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.I.
such projects with a corirractor(s) #versed pursuant to the Contractor's License Law.).
Grading s
O 1 am exempt, under' Sec. B. & P.C. for this reason
Driveway Enc. `
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION' '
I herebyaffimithat I have a certificate of consenPto self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.).
Policy Now -. Company '
i.
Dopy is:filed with the city, ❑ Certified copy is hereby furnished.
TOTAL 3 la —6 3-
' CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need 'nor• be completed i/ the permit. is for one hundred dollars ($100) .valuation
. or less.) _
I certify that In the'performance of th0 work for which this permit is issued, I shall not
employ any person: in any manner sous to become subject to the Workers' Compensation _
Laws of California
Date Owner
NOTICE 'TO APPLICANT: I/, ' after. making this Certificate of Exemption you 'should become . ' ' -ZONE: BY:
'subject to the •Workers' Compensation provisions o/ the Labor Code, you must forthwith ..
. comply with such provisions or this permit shall be deemed revoked. •. Minimum Setback Distances: .. -
Front Setback from Center Line
—Rear-Setback from Rear Prop. Line
WARNING: FAILURETO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND, Side StreetSetback-from Center Line "
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;' . Side Setback from Property'Line-
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
. ATTORNEYS FEES.
' This is a building permit when properly filled'out, signed and validated, and is subject to FINAL DATE INSPECTOR'
expiration if work thereunder is suspended for 180 days. '
TWYI
I certifythat I have read this -application and state that the above information is correct: a Issued b : "Date
I agree to.comply with all city and county ordinances and state laws. relating to building y
construction, and hereby authorize representatives 'of this city. Ao enter the , above. jl Q
mentioned property for inspection purposes , ,Validated by:
Signature of applicant DateQJ
Mailing. Address Validation: I 13
City, State, Zip OLP
-
} .. Bjl
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBINU FEES'.
.1ST FL. SO. FT. @
2ND FL. SO. FT. @
FOR. SO. FT. @
GAR. SO. FT. @
CAR P. SO. FT. @
.WALL SO. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
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, TEM/PERM
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
SO.FT.GAR @ 3/4C
HOUSE SEWER
ASPIPING'
PERMIT, FEE
PERMIT FEE
PERMIT FEE
H
DEL'
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)
OTHEWAPPJEQUIP.''
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
TFINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ _Plus'
x$ =$
LUMBER LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
,MESH
INSULATION/SOUND
FINISH GRADING
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS.
GARDEN WALL FINAL
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