15032 (BLCK)Qum&
P.O. BOX 1504 N o. 1 5 0 3 2 ,
Building 53-485 Ave. Rubio LA QUINTA, CALIFORNIA 9
Address
2253
s
Owner
Mailing
Sterling Homes BUILDING: TYPE CONST. OCC. GRP.
Address P.O. Box $50
A.P. Number
City Zip Tel.
La Ouintae CA 92253 564•-1966 Legal Description
Contractor251 of 4' high garden wall
i andel Ventures, Inc. Project Description �
Address
Sate
City Zip Tel.:
State Lic. B 638535 City 859
& 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
I hereby affirm that I am licensetl'tmcfer provisions of Chapter 9 (comment ig with Section.
7900) of Division 3 of the Busine d Professions Code, and my license is fn full force and
SIGNATURE eJ �.� �..�..--"7— r -s 41 1 DATE
OWNER BUILDER'DECLARATION - '�^
lEstimated Valuation $466 00
�'>
I hereby affirm that I;am exempt from the Contractor's L -i ansa Law for the following• •
reason: (Sec. 7031.5,Buslriess and Professions Code: Any.%Ity or county which requires a
permit to construct, aher,rimprove, demolish, or repair an structure, prior to its issuance also
requires the applicant for such permit to life a signed�stfientent that he is licensed pursuant to PERMIT AMOUNT
the provisions or the Contractor's License low, Chapter 9 (commencing with Section 7000) of
Division 3 of the Businoss and Professions Code, or'that. he Is exempt therefrom, and the basis
for the alleged exemgdon. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant fo a civil penalty of not more than rive hundred dollars ($500).
0. 1, 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. !§ 4Q
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, Mech.
provided that such Improvements are not Intended or offered for sale. If, however, the building
orImprovement is sold within one year of completion, the owner -builder will have the burden Electrical
or proving that he dM not build or inprove for the purpose of sale.)'
❑ I, as owner of the property, am exclusively contracting with licensed contractors to torr Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts for S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's license Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereb %affirm that I have a certificate of consent to self -insure, or a certificate of
Worker'smpensatian Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
POlicy o. Company
$Copy is filed with the city, ❑ Certified copy is hereby furnished.
TOTAL 15.00
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed N the permit Is for one hundred dollars (5100) valuation -
or less.)
I certify that in the performance of thq 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, d, after making this Certificate o! 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 ($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 property filled out, signed and validated, and is subject to
expiration It 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
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Ce
e—
Rear Setback from Re p. Lin
Side Street Setba om Centi
Side Setback frorRPrope(fy&jne_
FINAL DATE
Issued by:—
Validated by:
Validati
J
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. I SO. FT.
WALL SQ. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
_
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.'
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
u
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, 13.7.U.
SO. FT. RESID ® 1 Ve c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® Y4c
HOUSE SEWER
FRAMING
FINAL INSP.
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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
u
WATER SYSTEM
GRADING
cu. yd.
$ . plus x$
=$
LUMBER GR.
FINAL INSP.
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 SIGNATURES/INITIALS.
GARDEN WALL FINA_
♦ P7
HIGH;
CIT OF LA t-A�NT
BUILDING & SAFF—TY _PA�iT
Cot4ONTIONAL.
R
1 1,
S PER
INST
. DK; "t's'ly
Aid.
H PROPANE TANK ENCLOSURER
0SM—AVENIDA" RUBIMI-�_---'-,
B J-6
41
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