15263 (SIGN)44
P.O. BOX 1504 No. 15263
Building 78-790 y My ��� 78-495 CALLE TAMPICO
Address- LA QUINTA, CALIFORNIA 92253
Owner ! __S ajrtgri La
Mailing, BUILDING: TYPE CONST. OCC: GRP.
Address -tame
A.P. Number
C�• ity Zip T
l. -
Q���=fie CA g2� _'°' Legal Description
ContractorYg..
Imperial Sign Project Description` '
Address
46-123 Calhoun St.
n io, ,Cla Zip922t3 Te1.'347--356€
,.,State Lic. City
,,,.,State
& Classif.. C4,5 207136 Lic. # 223"' Sq. Ft. No. No. Dw.
- "
Size - Stories Units
Arch., Engr.,--
'
Designer New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑•
Address Tel.
City - 7zip State
Lic. #
t/it
CONTRACTOR'S DECLARATION
I hereby affirm t)fat 1 am licensed under pr9visions of Chapter 9 (commencing with Section
7 ) of DivisiQ /of the Business and P essi ns Code, and my license is in full force and
SIGNATURE DATE '
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation $4 X200. 00
reason: (Sec. 7031.5,Susiness 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 -
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 five hundred dollars (8500).
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.
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.)
❑ I, 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,l, - -
such projects with a contractors) Ikensed pursuant to the Contractor's License Law.)
O I am exempt under Sec. B. 8 P.C. for this reason Grading '
Driveway Enc.
Date owner Infrastructure
mis,,cellaneouE 63.00
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's CWp€nsation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
_ Polic Company
opy is filed with the city, ❑ Certified copy is hereby furnished.
TOTAL 63.0,0
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed If the permit is for one hundred dollars (8100) valuation '
or less.) J
I certify that in the performance of the work for which this permit is issued, I shall not -
any person in any manner so as to become subject to the Workers'Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT. d, 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 shell be deemed revoked. Minimum Setback Distances: - -
Front Setback from cenyt�er Line
Rear Setbackr0 ar Prop. Line
WARNING: FAILURE TO SECURE.WORKERS'COMPENSATIONCOVERAGE IS UNLAWFUL, AND Side Streeet k from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE y
HUNDRED,THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Sidc Sback from. PfOpert L»lite
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND - etetV �/
ATTORNEY'S FEES.
This is a buildin FINAL DATE \ INSPECTOR
g permit when properly.filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days: �
1. certify that I have read this application and state that the•above information 1s correct. Issued by: D to cs "'g -m t
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-.. t�!
mentioned property for inspection purposes. Validated by:
Signature of applicant Date \\ v
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ® oMOBILEHOME
SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
l
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT.
TEMP. POLE
URINAL a
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
+INAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
F AL INSP. /KS _
/
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 ® 1+/e c
SEWAGE - DISPOSAL
GAR. FIREWALL
SO.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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
+INAL INSP.
BOND BEAM
WATER SYSTEM
GRADING_
cu. yd.
$ plus x$
_$
LUMBER GR.,
F AL INSP. /KS _
/
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL