14311 (SOTB)4
P.O. BOX 1504
Building 55 -120 -Riviera 78-495 CALLE TAMPICO
Address LA OUINTA, CALIFORNIA 92253
Owner David a Sari
Mailing Same
Address
City Zip
La Quints, CA
Cont ctor
. ry Allen
Address
P.O. BOX 1 25.
No. 14311
BUILDING: TYPE -CONST.• a M OCC. GRP.
Number
92253 ( )$ Legal Description
Project Description InSta11. B.. B.Q.
Cita Quinta, CAA, zip 92253
State Lia
& Classif.. B 559460
Arch.; Engr.,
Designer
Address
Tel.:
(619)771-1008
City
Lic. #
City Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
�Zr.eby affirm that I am licepsed under p ovfsions of Chapter 9 (commencing wi Section
fDsion3: ofthe sBus'n ss and ProfestonsCodend my license is'in f II((fhorc gantd�
ffect. #�d�4! E
GNATU 5 "'' iii. DATE
OW ER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License. Law for -the following
reason:. (Sec. 7031.5,Busfness and Professions Code: Any city or county which requires .a
permit to construct, alter, 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 or 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 rive hundred dollars (8500).
O 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 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
- or improvement 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 or sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-=
struct the project. (Sec. 7044, Busfness'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) Ucensed pursuant to the Contractor's'License Law.) -
❑ 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
❑ Copy is filed with the city. O Certified copy is hereby furnished.
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add.❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation. $2,,50 0.00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if 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 pgrson In any manner so as to be me subject
xto�the
Q Workers' Compensation'
_(Lowe �f1tGa�1(}o tj¢ Owner J/�jl1+i'�'ti
NOTICE TO PPLICANT. t, alter making this Certificate of Exemption you should become , ZONE: ' BY:
subject to the Workers' Compensation provisions �of the Labor Code,- you must forthwith
comply with such provisions or this permit shall be deemed revoked. - Minimum Setback Distances:
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.
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 of this city to enter the above-.
mentioned property for Inspection purposes.
Signature of applicant Date
Mailing. Address
City, State, Zip
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setpack from Center Line
Side Setback fro erty Line
FINAL DATE SP
Issued b . f' to Per I
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL.' SO. FT.
BONDING
YARQ.SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. ®
OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAA EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE I DRYER
FINAL INSP.
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, ET.U. v
SO. FT. RESID ® I% c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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.IEOUIP.
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
/
F AL INSP. ��(
!!! /
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTIO —'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
110 amu, -
e, I �m
V-trlmgvm�
- -
� GICUY- �pM� �
(,,?,r*) lb 4£ &tvw w. INW.
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