14378 (DEMO)P.O. BOX 1504 N o . 14378
Building 75-483 Mony 113 78-495 CALLE TAMPICO -
Address LA OUINTA, CALIFORNIA 92253, —
Owner Ray Laird
MailinBUILDING:- TYPE CONST. OCC: GRP.
Address
A.P. Number
CityZip Tel.
- Legal Description
ContractorProject Descr' tion interior Demolition
Advanced Improvemehts
Address
81-771 Oleander #3
Cifyrda,c�; Zip..922fl� T145-5539.
State Lic: B $��� 6 Cit
& Classif.. Licy# 3431 -Sq. Ft. No. No. Dw.
•.. Arch:, Engr., _ Size Stories - .-Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ '-Demolition ❑
Address Tel.
City Zip State
L•ic. #
LICENSED CONTRACTOR'S DECLARATION
hereby�a'ffirin thatltam IrcQnsed under provisions of Chapter 9'(commencing w' h Section
of Div' ion 3 o tthe Business and Professions Code, and my license 1 jktu o ce and
gffect: �sar
�LGNATURE (k ; DATE -
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following.
reason: (Sec. 7031.5,11usiness 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 file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Dlvlslon 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 Plan `Chk. Dep. -
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).. -
O 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. 45af�
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.)
O I, as owner of the property, am exclusively contracting•with.licensed contractors.to con- Plumbing y
struct the project. (Sec. • 7044, Business and .Professions Code: The Contractor's License Law -
does not apply to an owner of propertywhobuilds or Improves thereon, and who contracts for S. M. 1. .
such projects with a contractors) #censed pursuant to the Contractor's License Law.) ,
0 I am exempt under Sec ` B. 8 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 Comp nsation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
opy is filed with the city. ' O Certified copy Is hereby fumished:.
TOTAL 45e
CERTIFICATE OF EXEMPTION FROM'% REMARKS
1 SSS 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
ate Owner
NOTICE TO APPLICANT: H,' after. 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.
M i n j m u m Setback Distances: -
Front Setback from Center Line
• ,.�'
i Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Setback from Center, Line
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 Property .Line
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
FINAL DATE INSPECTOR
expiration it work thereunder is suspended for.180 days.
y s-
I certify that I have read this application and state. that the above information is correct.
. 'Issued by: Date Permit
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-.
0
mentioned properly for inspection purposes.
Validated by:
—
Signature of applicant Date
i
Mailing Address
Validation:
I
City, State, Zip �•
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. ®'
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SQ. 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 FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL . FLOOR SUSPENDED
-
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.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 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
NAL INSP. ��
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIO ,
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL