15113 (BLCK)Addtling
ess 524-333 Bermudas
Owner
Arthur R. Carducci
.. Mailing
Address SaMz,
City .
LaQuinta-
" Contractor
O` M4
Address. .
Zip
92253 -
4
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
No.15113 '
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description
Gity •
Zip
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
effect.
-SIGNATURE DATE
_
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
Estimated Valuatl4cl�
¢i
rr,r
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
•
permit to construct, atter, 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 Ucense Law, Chapter 9 (commencing with Section 7000) of
- -
-
• Divislon 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
7031.5 'any for -
P.lanChk. Dep.'
-
• for the alleged exemption. Any violation of Section by applicant a permit
' subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
'I, as owner of the, property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
t'ioflSt.
�. V Q
• Professions Code: The Contractor's License Law does not apply to an owner of property who
•
Wilds of 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 wfil have the burden
Electrical
.-' 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-
Plumbing
' slruct the project. (Sec. 7044, Business and -Professions Code: The Contractor's Licenser Law
.
does not apply to an owner of property who builds or improves thereon, and who contracts for
S.M.I.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
'
Grading
11I am exempt under Sea B. t: P.C. for this reason
Driveway Eno.
Date'
Infrastructure .
.ower
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.) -
Polic'y No. Company
❑ Copy is filed with the city. . ❑ Certified copy is hereby furnished.
TOTAL
15.00
CERTIFICATE OF EXEMPTION FROM
REMARKS
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 thg work for which this permit is issued, I shall not
employ any person in any manner so as to`become subject to the Workers'•Compen`sation
Laws of California
Date Owner
NOTICE .TO APPLICANT. ff, after making this Certificate' of Exemption you should become
ZONE:
Y:
'-s6bject to the Workers' Corripensadon provisions of the Labor Code, you must forthwith --
_
MInIR1Uft1 $2tsa
ences:
comply with such provisions or this permit shall be deemed revoked. -
'•.g
r�t� from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 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 ($100,000), 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.
FINAL DATE
INSPECTOR
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 -have read this application and state that the above information.is correct.
Issued by:
DatePermit
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. PLUMBINU FEES
1ST 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
CAR P. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/<c
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
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 9�
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL