14360 (RC)Building
Owner
44
P.O. BOX 1504 No. 14360
7€3_572. j1ey 111 78-495 CALLE TAMPICO.
LA QUINTA, CALIFORNIA 92253
Carl Karcher Enterprises VN
BUILDING: TYPE CONST. OCC: GRP
Mailing,
Address 1200 N. Harbor
City Zip
P. Number
Anaheim, CA 92803 (714) 491-4345 Legal Description
Kitchen equipment and decor
C41M"Karcher .?,nt. Project Description
State Lic.
& Classif.
Designer
Address
same
.. .
1remadels gas.&,electric relocate
X. Harbor
:im CA Zip 92��l3
'0 39671.0
104.91-4345
Lip'# 5
City (zip (state C24484
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under,provisions of,Chapter 9 (commencing with Section '
'-,/7000) of. Divigion 3.of the Business and Professions Code, and my.license isin full force and
Neff( ct,
SIGNATURE DATE
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, 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,
the provisions of the Contractor's License Law, Chapter 9 (commencing. with Section 7000) of -
Division 3 o! 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 o! not more than five hundred dollars ($500). ..
❑ l,.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;
providedthat such Improvements are not Intended or offered for sale..!!, however, the building
or Improvement is sold within one year of compledon,. the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
M. O:I, 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
such pro%ects�lwhh'a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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
0.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 i1 the permit is. for one, hundred dollars ($100) -evaluation
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
Date Owner
NOTICE TO APPLICANT. if, after making this Certificate of • Exemption you 'should become -
subject to the Workers' Compensation provisions of the Labor. Code, you must- forthwith
ZONE:
BY:
comply with such provisions or this permit shall be deemed revoked.
Sq. Ft.
Size
No. No. Dw.
Stories:' Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
._
Rear Setback from Rear-Prop.,Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
'UP,
Side' Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINESTO ONE
HUNDRED THOUSAND DOLLARS. ($100,000), IN ADDITION.TO THE COST OF COMPENSATION, '
Estimated Valuation15'
$15000.00
PERMIT
AMOUNT
Plan Chk. Dep.
ATTORNEY'S FEES.
Plan Chk. Bal.
•
Const.
Its t3 t;1
Mech.
;e Z «•3!J
Electrical
15. i
Plumbing
Issued by;
S.M-I.
I agree to comply with all, city and county ordinances and state laws relating to building
Grading
Driveway Enc.
Infrastructure
mentioned property for inspection purposes.
Validated by:
' Sigriature of applicant Date
TOTAL
JJJ . U
REMARKS
Validation:
City; State, Zip
NOTICE TO APPLICANT. if, after making this Certificate of • Exemption you 'should become -
subject to the Workers' Compensation provisions of the Labor. Code, you must- forthwith
ZONE:
BY:
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: ,
Front Setback from Center Line
._
Rear Setback from Rear-Prop.,Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
'UP,
Side' Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINESTO 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 p'e'rmit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR 1Y
expiration it work thereunder is suspended for 160 days.
I certify that I have read this application and state that the above information is correct.
Issued by;
Date—
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.. '
'
I
mentioned property for inspection purposes.
Validated by:
' Sigriature of applicant Date
".Mailing'.Address
Validation:
City; State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
ROCK STORAGE
DRAINAGE PIPING
WALL SQ. FT.
METER LOOP
DRINKING FOUNTAIN
SO. FT. ®
OTHER APPJEOUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
TEMP. POLE
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FRAMING
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR Q 3/ic
HOUSE SEWER
GAR. FIREWALL
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 PLUMBIN — f
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
UGH WIRING -f
DUCT WORK
ROCK STORAGE
FOUND. REINF.
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
/,2,' �0
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION sl�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL