14439 (BLCK)44
'P.O. BOX 1504 No. 14439
Building 52-020 Ave. Ramirez 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner Dav-1 $ Ross PMiller
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address P.O. BOX 722
A.P. Number
CityZip ITel-
La
Quintan CA 92253 564-0273 Legal Description
ContractorProject Description 85 f+ ,C2$ 4' high block wall_
Pacific Trades
Ad�dres
City Zip Tel.:
State Lic. City
.& Classif. B 425381 Lic. # 1955 Sq. Ft. No. No. Dw.
Size Stories Units
Arch.; Engr.;
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition" ❑
Address Tel.
City Zip State
Lic. #
VLtCENSED.CONTRACTOR'S DECLARATION
I her ,f ffirm that Rrj�censed unler proAlons of Chapter 9 (commencing with Section
7000) of I sion 3 of h@,BuWrvess and professions Code; a d.my li ense. is in fu force and.
effect V �✓ 11-1 / 1 �.
GN Tf DATE
OWNER -BUILDER DECLARATION
Estimated Valuation $2 '
I hereby affirm that I am exempt from the Contractor's License Law for the following t553•-00
reason:, (Sec. 7031.5,Business 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 file a signed statement that he.is licensed pursuant 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 alleged exemption. Any vfo/axon of Section 7031.5 by. 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a chill penafty'of not more than rive hundred dollars ($500) _
❑ I, as owner of the property, or my employees with wages as:their sole compensation; will Plan Cfik. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 45.00
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 or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical
of proving that he did not build or 6nprove for the purpose of sale.) -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
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 S. M. 1. .
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner 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, ora certified copy thereof. (Sec.. 3800, Labor Code.)
Polilcy No Company
,e py Is filed with the city. ❑ Certified copy is hereby furnished.
Cs
TOTAL
45.00
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
REMARKS
(This section need not be. completed N 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, *1 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: If, atter making this Certificate of Exemption youshould 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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL. 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, ..
Rear Setback from Rear Prop./^ne
Side Street Setback from 9, f Line
/
Side Setback from .Prope Ine
DAMAGES AS PROVIDED FORAN SECTION 3706.OF'THE LABOR CODE; INTEREST, AND.
-
-
ATTORNEY'S FEES.
Ttiis'ls a building peimit when properly filled out; signed and validated, and is subjecnto
FINAL DATE
J/- yn
Q INSY�ryTOR
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 ,oV this city to, enter the above-.,�spt
mentioned property for Inspection purposes.
Signature of applicant Date
Mailing Address
• ISSUed by:
Validated by:
Validation:
Date l -Pe mit
n /
V
_ �+
�\
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
f ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO. FT.
OTHER APPJEOUIP.
REINF. STEEL
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+A c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
INSULATION/SOUND
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 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
•r,
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL'
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL