14738 (ELEC)Building
Address qA..*'
P.O. BOX 1504 NO. 14738
78-495 CALLE TAMPICO
?! a ty LA QUINTA, CALIFORNIA 92253
Owner
Bruce Pickett
Mailing
Address 54-811 A.Veaida Rubio
City I Zip ITel.
%d[aZTiL� LtJ3 �
Contractor
Address
State Lic. City
& Classif.. Lic. #
Arch., Engr.,
t Designer -
Address Tel.
City( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) t.of Division 3 of the Business and Professions Code, and my license is in full force and
` effec-
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,Bustness.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 rile a signed statement that he is licensed pursuant to
the provisions of the'Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 or the Business and Professkms' 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
su jects the applicant to a civil penalty of not more than five hundred dollars (8500).
dkI, as owner of the property, or my employees with wages as their sole compensation, will
do he work, and the structure is not 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
builds or impmves 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 .Professions Code.-,'The.•Coniractor's License Law
does not apply to -an, owner of property who builds or improves-thef`eon' and who contracts for—
such projects with a cgntractor(s) (kensed pursuant to the Confrector,'s Ll e`nse-la"w:) •"""^"'
❑ I am exempt under Sec. /B. & P.C. for this reason'�'
All 1 ?17111
Date 'Wi 11 .77 owner �"' ! i' .f Of
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.
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.)
I certify that in the performance of the 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 of Exemption you should become
subject io the Workers' Compensa l n 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
LDING: TYPE CONST.. OCC: GRP.
P. Number
Description
t Description ChFtnat—, 43Ar-Vit-A nPkf�Pl tO
Sq. Ft. No. No. Dw.
Size Stories Units -
l New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation.
$'300.07
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.-
-Electrical -
33.50
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
:33.
REMARKS
ZONE: BY:
Minimum'Setback Distances -
Front Setback from Center Line
Rear Setback from Rear Prop., Line
Side Street Setback from Center Line
Side Setback from. Property Line
FINAL DATE INSPECTOR
Issued by: Date P�Permit. --- I-'
Validated by:
Validation:
CONSTRUCTION ESTIMATE
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. I SQ. FT.
WALL SQ. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION. $
NO. ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
NO. PLUMB!
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APP./EQUIP.
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.
SQ. FT. ® c
BATH TUB
GRADING
cu. yd.
$ -Plus-X$-=$
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINAL INSP.
SO.FT.GAR ® 3/ic
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 3�
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
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 FINAL