15019 (BLCK)Building
Address
Owner
� d I
P.O. BOX -1 504
No. 15019
78-495 CALLE TAMPICO
7 ACl'px9ida CeSrA anza LA OUINTA, CALIFORNIA 92253
Francisco Esmeralda
Mailing
AddressP.O.BOX 138
I
j . City Zip JTel.
La Otainta " 32253
Contractorow-nerjd
Uilder
Address
City Zip Tel.:
State Lic. City
& Classif.. Lic. #
" Arch., Engr:;
Designer
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description 4� "' It.- of 41 garden wall an
172 If of. 5.... stir en. wall.
Sq. Ft.
Size
New ❑ '
No:��`:
Stories:
Add ❑ -Alter ❑
Address
Tel.
CERTIFICATE OF EXEMPTION FROM
REMARKS
City
Zip
State
Ljc. #
' '
LICENSED CONTRACTOWSMECLARATION .
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of:the Business and Professions Code, and my license is in full force and '
-
I certify that in the performance of the work for which this permit is issued, I shall not '
I SIGNATURE DATE
-
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors 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, demolish, or repair any structure, prior to its issuance also
requires the applicant for such•permit to file 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 Prolesskins 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
ubjects the applicant to a civil penalty of not more than 1111 hundred dollars
I 77N"',,",.'"
NI, 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 of sale.) .
I O I, as owner -of the property, am exclusively contracting with licensed contractors to con-
' slrucl 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 contractor(s) (Icensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec B. & P.C. for this reason
Estimated Valuation
4-
PERMIT
-
Plan Chk. Dep. 5. -
-
Plan Chk. Bal..'
COW. '
Mech..
'
Electrical
Plumbing '
S.M.I.
Grading
Driveway Enc.
Date Owner r s vR ..x- �� se<�L- t6 #1 ey,
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby'affirmthat I have a certificate'of'consent to self -insure, ora certificate of
Worker's Compensation Insurance, or certified copy thereof. (Sec. 3800, Labor Code.).
Policy No. company
O Copy is filed with the city, ❑. Certified copy is hereby furnished. - -
-
-
No. Dw.
Units
Repair ❑
AMOUNT
72. LIU
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 ($100,1100), IN ADDITION TO THE COST OF COMPENSATION, .
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,ANTEREST, AND. .
ATTORNEY'S FEES.-
-This is abuilding permit when properly filled out, signed and validated; and'is subject to.
expiration if work thereunder is suspended for 160 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 inspectlon purposes.
Signature of applicant— Date
Mailing Address
City, State, Zip
Rear Setback fromR p: Li
'Side Street Setback Ce
Side Setback fir rAict Line
FINAL DATE EC .OR
°Issued by: Date ' Permi
Validated by:
f
Validation:
TOTAL YGw 13t1
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE -
his section heed not be completed if Me
R mp pemrft is for one, dollars ($100J 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
z "
Laws of California
Date Owner
NOTICE TO APPLICANT: ff, agei making. this 'Certificate of Exemption you .should become..
.ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply wan such provisions or this permit shall be deemed revoked:
'
Minimum Setback Distances:
Front. Setback from Cent' ir1
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 ($100,1100), IN ADDITION TO THE COST OF COMPENSATION, .
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,ANTEREST, AND. .
ATTORNEY'S FEES.-
-This is abuilding permit when properly filled out, signed and validated; and'is subject to.
expiration if work thereunder is suspended for 160 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 inspectlon purposes.
Signature of applicant— Date
Mailing Address
City, State, Zip
Rear Setback fromR p: Li
'Side Street Setback Ce
Side Setback fir rAict Line
FINAL DATE EC .OR
°Issued by: Date ' Permi
Validated by:
f
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWQ FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
Y
ARD SPKLR SYSTEM
2ND FL. SO. FT. p
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
WALL SO. FT.
WATER HEATER
DRINKING FOUNTAIN
FINAL INSP.
URINAL
SO. FT. ®
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
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, B.T.U.
SO. FT. RESID ® 1'A c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
INSPECTOR'S SIGNATURESIINITIALS
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEETPLUMB. 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
FINAL INSP.
ROOFING
(v
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
U %� rOA
FIREPLACE
S
SPARK ARRESTOR
GAR. FIREWALL
09 A
!VIly �
LATHING
L
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL