15635 (PC)TA hf
/ h
4
P.O. BOX 1504 No. 15535
Building•% Sr'i�� 78-495 CALLE TAMPICO
Address �M .i LA QUINTA, CALIFORNIA 92253
Owner kl.�I1ael P. Laird
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address Sane
A.P. Number
City Zip Tel.
La Qui)ht8, CA 92253 Legal Description
Contractor Awning over entrance
Couu try Club Awning Project Description
Address
.74-877 Joni Dr,.", Ste. 8
C'Yalni Desert, � 92264 Te1.34�-SJOF,
State Lic. City
& Classif.70990`7 Lic. # Sq. Ft. No. No. Dw.
- Arch., Engr.,; .
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip ,., State
f A Lic. #
f LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thaij•am licensed under provisions of"6hapter 9 (commepc'ing-with Section
I
Divisi-on e3 fithe Business and Piofessions ode, and my license is In fulkforoe and&
�ffe� : = G•a j%CC t✓ .�`ed� " r� y
�1GNATURE DATE -
OWNER -BUILDER DECLARATION y
I hereby affirm that I am exempt from the Contractors License law for the following Estimated Valuation $2'1,596.00
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 applicant for such permit to rile 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 '
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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). ,
❑ 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. 54.00
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. B, however, the building
or Improvement is sold within one year or completion, .the owner -builder will have the burden .Electrical
of proving that he did not build or improve for the purpose of sale.)
❑ 1, 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 builds or improves thereon, and who contracts for S.M-1,
such projects with a contractors) licensed pursuant to the Contractor's License Law.) .
❑ I am exempt under Sec B. 8 P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure
r WORKERS' COMPENSATION DECLARATION
I hereby ffirm that I have a certificate of consent to self -insure, or a certificate of
Worker's pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Po icy Company
Copy is filed with the city, ❑ 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, 1 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., n, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Distances:
comply with such provisions or this permit shall be deemed revoked. Minimum Setback D,/`�
Front Setback from Center Li' ae'*,
Rear Setback from Rear, P op./Line
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 from -Center Line,
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Side Setback from P4perty: Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND yI
ATTORNEY'S FEES. ' _X.
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR ,�
expiration if work thereunder is suspended for 180 days.
1 certify, that I have read this application and state that the•above information is correct- ISSUed by:' Date Pert t a
I agree to comply with all city rite representatives
ordinances and state laws relating h building �\` j/
construction, and hereby authorize representatives-sof this city to enter the above-. tTv
mentioned property for inspection purposes.. Validated by:
Signature of applicant Date, U
Mailing Address
Validation:
City, State, Zip � V
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW 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. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EOUIP.
DRINKING FOUNTAIN
SO. 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, 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
GAR. FIREWALL
SO.FT.GAR ® 3/hc
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 APP./EOUIP.
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 SIGNATURESIINITIALS
GARDEN WALL FINAL 7d