15017 (MECH)44
1 + c P.O. BOX 1504 N o . 15 017
Building 78-950 Hwy 111 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner •
:ralt1 art
Mailing' lE: BUILDING: TYPE CONST. OCC: GRP.
Address
A.P. Number
City Zip Tel.
La Quil a, CA 92223. " Legal Description
Contractor Install- (1) 10 ton, and (1—
Project Description
Waatharali\ A/C & Refrig. , * plc.
A dress _ � i ., 5' tom- rf3oE• rrcur��.-'a�.rC�ndlt�.as�2n� unit. .
C3 3 �zraa above garden c6nt r ,
c9Dhave Naha ZipAZ 86440 (520 768-1505
State Lic.�� ���� City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr:;
Size- Stories Units
.. .. _ . _ .. ..
Designer New ❑ Add ❑• Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION v
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
`ect f ��'+ e�t ;lbs',.-^,...�s¢.ed"'iJ`.,.+�.s••?^.�•yr4 '. . . _
SIGNATURE C '\ DATE
OWNER -BUILDER t DECLARATION Estimated Valuation $181 -000.00
I hereby affirm that 1 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 signedstatement that he is licensed pursuant to - PERMIT - "AMOUNT • '
the provisions of the Contractor's License law, Chapter 9 (commencing' with Section 9000) or
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 (5500). •• -
0 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.
Professions Code: The Contractor's License Law does not apply to an owner of property who '
• !wilds or improves thereon and who does such work himself or through his own employees. Mech. r
provided that such improvements are not intended or offered for sale. If, however, the building, -• v
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.)
❑'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 contractor(s) pcensed pursuant to the Contractor's License Law.)
O bam exempt under Sec B. & P.C. for this reason Grading
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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.) .
Po16cY No,. Company
Copy is filed with the city. 0 Certified copy is hereby furnished. }�
TOTAL 35.00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE".
(This section need not be completed if the permit is for one . hundred dollars (5100) valuation
or less.)
1 certify that in the performance of thg 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:, N, after, making this Certificate of Exemption you should become
ZONE:
subject to tie Workers' Compensation provisions of *the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. ..
-;-BY:
Minimum Setback Distances: '
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING:. FAILURE TO SECURE WORKERS'COM PENSATION 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 ($1.00,000), IN ADDITION TO THE COST OF. COMPENSATION,
Side Setback from Property Line '
DAMAGES AS PROVIDED FOR IN, SECTION.3706 OFTHELABOR. CODE, INTEREST, AND
ATTORNEYS FEES.
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.
I certify that I have read this application and state that the above information:is correct:
Issued by:. -
Date
17
I agree to comply with all city and county ordinances and state laws relating to building'
Q
construction, and hereby authorize representatives -of this city to .enter the. above-.
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
1.
Mailing Address
Validation:
D
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. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
4I NAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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
SO.FT.GAR ® 3/.c
HOUSE SEWER
MESH
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
UNIT �S
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.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
4I NAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
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 SIGNATURESlINITIALS
GARDEN WALL FINAL