14930 (WALL)54425 Avenida Alvarado
IIIIIII VIII III VIII IIII 56
IE
4 Quh(A
P.O. BOX 1504 No. 14930
Building t, 78-495 CALLE TAMPICO
Address 54-4.5 Ave.;"Uv bade LAOUINTA,CALIFORNIA 92253
Owner
MailinBUILDING: TYPE CONST. OCC. GRP.
Address :a tic?
A.P. Number
City Zip
'_: I 'I""- rit a r CA 92253 Legal Description
Project Description 29 r O'' 6 • h h . and 76 o
P .f
Contractor -
TrTin S'r Qi l!44 Masonry
4
Address high garden i]_i
P.O. Box 1333
City Zip 92253 Te15,4`2u,
State Lic. City
& Classif. C-29 494257_7 Lic. # 12 2 P Sq. Ft. No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed undar provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Prolesslons Code, and my license is in full force and
ffect.
1CxtJATt1R RATE
OWNER -BUILDER DECLARATION Estimated Valuation + ?
I hereby affirm that I am exempt from the Contractor's License Law for the following Y f
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the appikarrt for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commenclog with Section 7000) of
Division 3 of the Business and Professions Code, or that he is exempt therefrom, and the basis
for rhe alleged exemption. Any vMhixlon of Section 703F.5 by any iipPlrcant for a permit Plan Chk. Dep-
subjecfs the applicant to a civil ponafty of not more than five hrindred dollars f S500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec 7044, Buisness and Const.
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, Mech.
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 Electrical
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Code; The Contractor's License Law
does not apply to an owner of property who hoWis or improves lheraon, and who contracts tot S.M.1.
such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent 10 self -insure, or a certificate of
Worker's Cot> ensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy f o" Company
' opy is filed with the city. I I Certified copy Is hereby furnished.
TOTAL 54.00
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 the 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. If, alter making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Li
Rear Setback from Rear Pr n
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback [rote er Lin
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 P r y Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEYS FEES. FINAL DATE11V0,ECTOR
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 slate that the above Information is correct. Issued by: Date Perm€t`
I agree to comply with ail city and county ordinances and stale laws relating to building
construction, and hereby authorize representatives of this city to enter the above- k9
menitoned property for ins purposes,. pop. r inspection Rr Dees;. Validated by: -
Signature of applicant Dale -
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL SQ. FT @ $
2ND FL. _ SO FT. g_
POR — SO FT @
GAR. SQ FT. @
CAR P. SQ FT ®
WALL SQ. FT
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
COLL. AREA
YARD SPKLR SYSTEM
ROUGH PLUMB
MOBILEHOME SVC. BAR SINK
HEATING (ROUGH)
POWER OUTLET ROOF DRAINS
FORMS
DRAINAGE PIPING
ROUGH WIRING
_
DRINKING FOUNTAIN
ROCKSTORAGE
URINAL
GAS (ROUGH)
WATER PIPING
HEATING (FINAL)
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
GAS (FINAL)
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN WASHER(AUTO)(DISH)
SERVICE
APPLIANCE DRYER
GARBAGE DISPOSAL
BOND BEAM'f_
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
GRADING
cu. yd.
$ —Plus—X$—=$
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC WATER CLOSET
FINAL INSP.
COMPRESSOR HP
POLE, TEM/PERM LAVATORY
—
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT SHOWER
REMARKS:
BOILER B.T.U.
SQ. FT. ® c BATH TUB
SO. FT. ® c WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID g 1+/a c SEWAGE DISPOSAL
FIREPLACE
SQ.FT.GAR @ 3/ac HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
GAR. FIREWALL
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 GOND. 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
ROCKSTORAGE
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'f_
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP
FRAMING
FINAL INSP.
ROOFING
—
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC,
FENCE FINAL
11 1NSPECTOFF'3 blUNA I UHU511N111ALS
GARDEN WALL FINAL
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