14866 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
Addrdess 52-975 C:arranza LA QUINTA, CALIFORNIA 92253
Mart:i21,`ire jo
Mailing
Address 52-975 Carranza
i
cityLa Quints I Zip 92253 ITel.
'
Contractor
M Owner/Builder
Address
BUILDING: TYPE CONST
A.P. Number
No. 14866
OCC: GRP,
Legal Description E.Qfwk. WAII
Project Description �' 1371 Carden Wa13. with
. - 5' - colu a;s
' City
Zip
Tel.:
State Lic.
City
& Classif.
Lic. #
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 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
effect.
I
.
SIGNATURE DATE
i
OWNER -BUILDER DECLARATION
E
I hereby affirm that I am exempt from the Contractors License Law for the following
f reason:_ (Sec.., 7031.5,Business and Professions Code: Any city or county which requires a
Estimated Valuation
'
I
PERMIT
AMOUNT
permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rue a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Plan Chk. Dep.
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 for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, -will
Plan Chk• Bal.
Const.
■■ rrttes
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
Mech.
Electrical
or Improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he didnot build or knprove for the purpose of.sale.)
Plumbing
p'1, as owner of the property, am exclusively contracting with licensed contractors to con,
struct 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
S.M.1•
such projects with a contractor(s) (rcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Grading
Driveway Enc.
Date owner
Infrastructure
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. ❑ Certified copy is hereby furnished.
�5
TOTAL
s�00
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
-
(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 thF 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: ff, after making this Certificate o! Exemption you should 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.
ZONE: BY: '
Minimum Setback Distances: -
Front Setback from Center L•
Rear Setback from Rear P i
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
Side Street Setback fro ter Li
HUNDRED THOUSAND DOLLARS ($100,00(3), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
Side Setback from P e y Lin
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. • , -
FINAL DATE
t ECTO
1
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 relatingto building
construction, and hereby authorize representatives -of this city .to enter the above..
mentioned property for inspection purposes.-
Issued by:
Validated by:
Date PeffT11
n
�V
Signature of applicant Date
Mailing Address
Validation:
M i
j City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. ®
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
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(A.UTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 34c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMIFEE 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 APPJEQUIP.
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
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIQNATURESlINITIALS
GARDEN WALL FINAL