15160 (SIGN)t! P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 78"950 HWY Ill LA QUINTA, CALIFORNIA 92253
Owner .Mc Donalds/Wal Mart
Address78-950 H%Y III'
City Zip Tel.
La Quinta . 92253
Contractor
. Superior Elec. &Iv,
1700 �'. Anaheim St.
Tel
Offing Beach r90813 860-995-9099
State Lia City
& Classif.C45e 271599 Lic. #,New app.
"Arch., Engr.'' " •
Designer" Richard Stage" ." .
Address . Tel
3935 Marney St 543-1222
City T
p State
'Safi Diego 9734' Lic.#" 1372
LICENSED CONTRACTOR'S DECLARATION
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
effect: --• .
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,Buslness and Professions. Code: Any city, or county which requires a
permit to construct, after, 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 o1 the Contractor's License Law, Chapter 9 (commencing with Section '7000) of
Divfslon 3 ofthe 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 penafty of not more than live hundred dollars ($500). - '
O I, 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• Bulsness 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,
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
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-
struct the project. (Sec. 7044, Business and.Protessions Code: The Contractor's License Law
- does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) pcensed 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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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 pparson 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
subject to the Workers' Compensation provisions of the - Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($1D0,000), IN ADDITION TO THE -COST OF COMPENSATION,
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
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.
I agreeto 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-.
mentioned property for inspection purposes.
Signature of applicant Date
.Mailing Address
City, State, Zip
LDING:-TYPE CONST
P. Number
No. 15160
OCC: GRP.:
,Legal Description
Project Description L iht;ertof logo arch
2 exposers neon signs
4 strips exposed neer
4 circuits total
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add•❑ Alter ❑ Repair ❑- Demolition ❑
Estimated Valuation
_ A.
PERMIT
AMOUNT
Plan Chk-.Dep.
Plan Chk. Bal.
Const. '
Mech.
Electrical
S30-00
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
130.00
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback -from Center Line
—Rear ck f ear Prop. Line
%Si_2f� Stre� Set c from Center Line
SSetback fro �roperty Line
nnG ��
FINAL DATF-I r•Ir n x' t'
Issued by:
Validated by:Ry
Validation:
te .1 Permit
�.—•-ter' ,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES '•
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. SQ. FT. @
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. @
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. @
OTHER APPJEOUIP.
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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
NAL INSP. l
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
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1+/. c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR @ 3/ic
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
FINAL INSP.
BOND BEAM
WATER SYSTEM
oe�GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
NAL INSP. l
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND r
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL