14353 (BLCK)P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 53-655 Ave. Rc'1i rairez LA OUINTA, CALIFORNIA 92253
Owner Jame': 13e'lknap
No. 14353
BUILDING: TYPE CONST.. OCC: GRP.
Mailing P.O.. Bax 297
Address
cFlZip
al€n. Desert, :A 92261
Contractor
Belknap Construction
And.ress3ox
v 29'7
r.
ciYa1I Desert, lip 922€1
State Lic. B 652815
& Classif. .
Arch., Engr.,
Designer
Address
Zip
t . .LICENSED CONTRACTOR'S
of
A.P. Number
Tel.
564--2783 Legal Description
Project Description'101.. ;0f,51, and 45' of
4' high block wall
Tel
City 2845
Lic. #
State ,
I is #
Sq. Ft. No.`:
Size Stories -
New ❑ Add, ❑ Alter ❑
TION
9 (commencing with'Section
my license'is in full force and
No. Dw.
Units
Repair ❑ Demolition ❑
SIGNATURE 4 - `<.�.i --" 1 DATE
OWNEWBUILDERDECLARATION
I hereb) affirm that I am exempt from the Contractors License Law for the following
reason: (Sec.. 7031.5,Bustness and .Professions -Cade:. Any. city: or county .which- requires a.
permit to construct, after, improve, demolish, or repairany. structure, -prior to its issuance also
repuires-the applicant for such permit to rile a signed -statementshat be is.licensed pursuant to
the, provisions of the Contractor's' License Law, Chapter 9"(Commencing with Section 7000) of
Estimated Valuation
-
• � - ^
PERMIT
AMOUNT
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
Plan Chk. Dep.
-
subjects the applicant to a civfl penalty of not more than five hundred dollars ($500).
01,as owner.of the property,.or my employees with wages as their sole compensation, will.
Plan. Chk. Bal.
Const.
�5 •�
do the 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
• Mech.
'
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 oneyear of completion, the owner -builder will have,the burden
of proving.that he dM not build or bnprove 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) #censed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec B. & P.C. for this reason
S.M.I.
-
Grading
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, or a certified copy thereof. (Sec. 3800, Labor Code.) -
Policy N - Company
Copy Is filed with.the city, .O Certified copy is hereby furnished.
TOTAL
25.00
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE'
REMARKS
(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 thF 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: N, after making this Certificate .of Exemption you should become
subject to (60 Workers' Compensation provisions of the Labor .Code, your must • forthwith.
comply with such provisions or this permit shall be deemed revoked
ZONE: - BY.: -
.Minimum Setback Distances: -
Front.Setback from Center Line
Rear Setback from. Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO'CRIMINAL PENALTIES AND CIVIL FINES'UP-TO ONE
' •
- SideStreetSetback.fromCenter•Line
/
.HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
-
Side Setback from
AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,. INTEREST, AND
ATTORNEY'S FEES.
Thisis a buildin
permit when properly filled out, signed and validated,'and issubject to .expiration
FINAL DATE
gPropeinDAMAGES
- ..INg
AA
It work thereunder is suspended for 180 days..
certify that I have read this application and state that the above information -is correct.
' ' Issued by: -
-Date1a((�agree
to comply with all city and county ordinances and state laws relating to building(/vconstruction, 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:
1
7`
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING; FEES"
1ST FL. SO. FT. ® $
UNITS
+'
2ND FL. SQ. FT. p
COLL. AREA
YARD SPKLR SYSTEM
ROUGH PLUMB.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
HEATING (ROUGH)
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
ROUGH WIRING
DRAINAGE PIPING
CAR P. SO. FT.
DUCT WORK
ROCK STORAGE
WALL SQ. FT.
'
DRINKING FOUNTAIN.
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
OTHER APPJEOUIP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
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
4p /
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID a 11A c
SEWAGE DISPOSAL
VENTILATION
SO.FT.GAR ® 3/oc
HOUSE SEWER
FIRE ZONE ROOFING
GAS PIPING
PERMIT FEE
FIREPLACE
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.
I
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
4p /
/ /Z/Z,1iQ
�
A
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND -
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESJINITIALS
•
GARDEN WALL FINAL