15314 (BLCK)M
r,
iJ
Building
Address 54-62
P.O. BOX 1504
78-495 CALLE TAMPICO
Ramirez LA QUINTA, CALIFORNIA 92253
Mailing
Address :Asma r as above
City Zip Tel.
La Quinta 922:53
Contractor
Address
A7-711
Zip Tel.:
92201. 1 347-0399
State Lic. I City
& Classif. 439904 Lic. #
Arch., Engr.,
Designer
Address Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that t 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
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,6usiness 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 Me a signed statement that he is licensed pursuant to
the provisions of the Contractors License law, Chapter 9 (commencing with Section 7000) or
Division 3 of the Business and Professions Code, or Natr he is exempt therefrom, and the basis
for the alleged exemption. Any vfoletdon of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penally or not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Confractor'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,
provided that such improvements are riot 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 inprove for the purpose of sale.)
❑ 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 contractors) (tensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
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
O Copy Is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that In the performance of lhp 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: ff, after rnakIng this Certificate of Exemption you should become
subject to the Workers' Cor pensation 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 Hermit when properly filled out, signed and validated, and is subject•to
expiration if work thereunder is suspended for 180 days.
1 certify that'l 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 -
No. 'x.531
BUILDING: TYPE CONST. •
A.P. Number
Legal Description.
Project Description 2103.E of 61
retaining Wali .and 20
OCC. GRP.
garden
1f of S'
wall on 4" .
garden wall
on 1141 retaining walla
Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑
Demolition ❑
1 ,
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
I a(D
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY: %
Minimum Setback Distances: �,.'``
Front Settbb' ro"m rr Cite
Rear S�tI! fr,off' Rear Pr'°p.
Side St et SetbFc6y-from Cente ` n\
Side S ted ck from Proerrty LirV
FINAL DATE \ INSPE0 09.0
Issued by: Date P r
Validated by: \
Validation:
t-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU 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
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 I
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 I EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE I DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL I 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. j
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
I
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH 1
GAS PIPING
PERMIT FEE (
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
I
MICRO FEE •
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE j • 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 I
WATER, HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
.,
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING l
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
ff
FIREPLACE I
SPARK ARRESTOR I
r
GAR. FIREWALL 1
LATHING
MESH 1
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL