15250 (BLCK)4
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 50--325 Mtn. Shadow LA OUINTA, CALIFORNIA 92253
Owner J.P. Ministrelli
Mailing
Address 50-445 At. Shadmi'
city.Zip Tel
La .Quihta, .CA 12253 554-1849
Contractor
Sam
City -
State Lic. I City
& Classif.6938 9 Lic. # 3625
Arch.; Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section
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, after, improve, demottsh, 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 of 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. fora permit
subjects the applicant to a civil penalty of not more than rive hundred dollars (8500).
❑ 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 lnprovements 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 provingthat he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to corn
slruct the project. (Sec. 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.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereb affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's�mpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy N Company
f:Copy is filed with the city. O 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 less.) -
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any pperson in any manner so as to become subject to the Workers' Compensation, .
Laws of California.
Date - Owner
NOTICE TO APPLICANT: If, after making this .Certificate of Exemption youshould become
subject to the Workers' Compensation provisions of the Labor Code, -you- must forthwith
comply with such provisions or this permit shall be deemed revoked. '
s
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 it 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
No. 15250
BUILDING: TYPE CONST. OCC: •GRP.:
A.P. Number
Legal Description
Project Description 275 I..f " • of, 6' high garden
*all -
Sq. Ft. No.
Size Stories
New ❑ Add ❑ Alter ❑
No. Dw.
Units
Repair Demolition ❑
ZONE: BY:
Minimum Setback Distances:' "
Front Setback from Center Line
Rear Setback from Rear Prop.,kin
Side Street Setback from � to .b e
Side Setback from Prop(p I / ' e
FINAL DATE INSPgg'/OR \�► /
Issued by:Date Peet U
Validated by: �\ a
ulaallon: �, ii ii �
Estimated Valuation $60,875.00
1
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const:
19�10. € 0
Mech.
Electrical ice"
Plumbing.
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
90. l o
REMARKS
ZONE: BY:
Minimum Setback Distances:' "
Front Setback from Center Line
Rear Setback from Rear Prop.,kin
Side Street Setback from � to .b e
Side Setback from Prop(p I / ' e
FINAL DATE INSPgg'/OR \�► /
Issued by:Date Peet U
Validated by: �\ a
ulaallon: �, ii ii �
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APFLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.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
ROCKSTORAGE
n /
FOUND. REINF. /-6 5
!!!
GAS (ROUGH)
METER LOOP
.HEATING (FINAL)
OTHER APPJEOUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
INISH GRADING
W—FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL