14617 (BLCK)'Ti4444
4"
P.O. BOX 1504
Building 52--334 Ave. Rubio 78-495 CALLE TAMPICO
Address LA OUINTA, CALIFORNIA 92253
Owner Dan Williams
Mailing
Address Same
City 7CA
ip Tel.
Lam, Quinta, 92253 1771-0536
Contractor
0�onei /Builder
Address
jZjp
State Lic.
& Classif. .
'Arch.; Eng r.,
Designer
Address
Lic. #
el.
No. 14617 -
WILDING: TYPE CONST. OCC: GRP.
.P. Number
>gal Description
1$0 9f161,
oject Description .' . 10' Of 5', c' nd
10' ..of. 41 high -garden black walk.
Sq. Ft- No.
Size Stories
New ❑ Add ❑. • ` Alter ❑
No. Dw
Units
Repair ❑
Demolition.❑ .
City
Zip
State
ZONE:
BY:
.
Lic. #
Front Setback from Centerline
LICENSED. CONTRACTOR'S DECLARATION
Rear Setback from RearProp Line
from4c, Line
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. -
Side Street Setback nter
SIGNATURE DATE
' OWNER -BUILDER DECLARATIONEstimated
I hereby affirm that I am exempt from the Contractor's License Law, for the following
Valuation $4 ��.��
7
FINAL DATE
_ reason: (Sec. 7031.5,Business and Professions Code: Any, city or, county which requires a
Issued'by:
PERMIT
AMOUNT
permit to construct, atter, Improve, demolish, or repair any structure, prior to Its issuance also
requires the applicant for such permit -to file assigned statement that he Is licensed pursuant to
the provisions of the Contractor's License; Law, Chapter 9, (commencing with Section 7000) of
by:
Plan Chk- Dep.
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
sbts the applicant to a civil penalty of not more than five hundred dollars ($500).
PIDas owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
Const."
�t
inot Z. 00
'do the work, and the structure is 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
McCh.
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
Electrical
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.) ..
Plumbing
O 1, 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 projects with a contractors) Vicensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B: & P.C. for this reason
S.M:I-
Grading
Driveway Enc.
Date t Owner :Aa - r,�„�-.:-:
Infrastructure
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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
72.00
REMARKS
CERTIFICATE OF EXEMPTION FROM
- WORKERS' COMPENSATION INSURANCE
- •-
-
(This section need not be completed If the permit is for. one hundred dollars ($100) valuation
' or less.)
If
I cert y that In the performance,9, the work for which this permit Is Issued, I shall not
employ any perso�Irany manner so'as to become -subject to the Workers' Compensation
Laws of California / ,/� ,+. /
.Date i, - ) rr,..*1 y.�Owner / - �!: /.,,-••�.r/
NOTICE TO APPLICANT lt, afte„,making-this Citc5te ol-Exemptan 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 ($100,000), 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 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-. .
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Centerline
Rear Setback from RearProp Line
from4c, Line
Side Street Setback nter
Side.Setback from Priipe. y Line
Y:
FINAL DATE
/J'I+IV PEC�r/�}
Issued'by:
Date',�L - Tt�rrmm it
Validated
by:
Validation:
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PI UMBINt�EEES r
UNDERGROUND
A.C. UNIT
COLL. AREA
IST FL. SO. FT. ® $
UNITS
�L
2ND FL. SO. FT.
HEATING (ROUGH)
YARD SPKLR SYSTEM
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
-DUCT WORK
ROCKSTORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CARP. SD. FT.
GAS (FINAL)
WALL SO. FT.
DRINKING FOUNTAIN.
SO. FT. ®
i
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
.FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET`
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vic
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
HOUSE SEWER
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 APPJECUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
i
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM G� ��g
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.,
FRAMING
.FINAL INSP.
ROOFING
y,
REMARKS:
VENTILATION
r
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Lt
/0.
13W, WALL
4
CITNif OvA-A, C VNTh
I 7rc
I DiNG %R"'INVIENT
BUI
Fr
j AL
AND P,LL-A,,PPLICABLE CODts
,TE.