14390 (RER)(AKj4U(4(.
t I *_U� Of *
Building 54-855 Ave. bio
Address
P.O. BOX 1504 N O JLr4 90
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253'
Owner migu.61 Paula zasagoza.
Mailing'
Address
City Zip Tel.
.Ira.Quint a, ..CA 92253
Contractor
erstek / Bui ld6r
Address . .. - .
Zip
11LDING: TYPE CONST: OCC: GRP. -
P. Number
gal Description
oject Description Bathroom Alteration ,
State Lic.
City
& Classif...
Lic. #
Sq: Ft.
No. No. Dw.
Size
Stories' Units
Arch.,- Engr.;
Designer :
New ❑ Add ❑
Alter ❑ Repair ❑ '. Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
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
s,
' effect:.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuatio®�
$6001.00,
I hereby affirm that I am exempt. from the Contractors License Law for the following'
reason: .(Sac;.7031.5,Business 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 file.a signed statement that he is licensedpursuant to:.
PERMIT
- AMOUNT'
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section. 7000) of
-.
Division 3 of the Business and -Professions Code, or that. he Is exempt .therefrom, and the basis
for the Any Section 7031.5 'any for
-
Plan Chk. Dep.
-
alleged. exemption. violation o1. .by applicant a. permit..
subects fie applicant to a civil penalty of not more than five hundred dollals.($500).
-
•.
1�.I, as owner of the property, or my employees with wages as their sole compensation, will
Plan.Chk. Bal.
16.25
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Cionst.
25.00
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 orofferedfor .sale.. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
or 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- .
Plumbing
• strucl the project. (Sec. 7044, Business and.ProfessJons Code: The Contractor's License Law
does not to who builds improves. thereon, for
S.M.I.
.
apply an owner of property or and who contracts
such projects with'a contractor(s) (#tensed pursuant to the Contractor's License Law.)
-
-
Grading
❑ 1 am under Sec. "B: 8 P.C. for this reason
-exempt
1 ,,,, _
Driveway Enc.
Date f r ' -'� Y'Owner ' t"'!'��
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I Aave 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; . O Certified copy is hereby furnished. .
TOTAL-
41.75
CERTIFICATE OF EXEMPTION FROM
REMARKS-*
WORKERS' COMPENSATION INSURANCE. -
(This section need'not -be completed if the. permit is for one hundred, dollars (S 100)' valuation
or less.) - - ..
I 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 toahe Workers' Compensation:
?- s' Co
Laws of California=J ✓� !.`r
Date �"'' 'Ta% : f Owner :...-y..a: - .• J _'
' '
. ,�QT/CE TO APPLICANT: ; If, -alter, making'• this -'Certificate of Exemption you should become-
ZONE:
' ' BY: -- - - - - .
subject to the Workers' CompbrIi"on provislons of the "Labor Code,. you must forthwith
comply with such provisions orthis.permit shaft be deemed revoked: •'
Minimum Setback Distances:
Front'Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE 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 ($100,070), IN ADDITION TO THE COST OF COMPENSATION; '
Side Setback from Property. Line
DAMAGES AS PROVIDED FOR IN. SECTION 3706 OF THE LABOR' 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 Permit
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:
Validated by:
Signature of applicant Date
Mailing Address _
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. -FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. 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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR @ 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
REMARKS:
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 PLUM
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 APPJEOUIP.
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
/!`/vii/� X—
l�
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