14618 (PLBG)P.O. BOX 1504 N o . 14618 -
Building 53a-905 Ave. Bermudas 78495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
vwi�c4 Greg Oardes
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address SaMe .
A.P. Number
City Zip Tel.
La .Quintal, CA 92253 ., Legal Description
ContractorReplace 80: Of exiSting
O`'�3n4t/Suild6 Project Description
Address ...gas. -pipe in sideyard
City Zip Tel.:
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: #
t _
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
OWNEWBUILDER DECLARATION Estimated Valuation 20Q i9
I hereby affirm that I am exempt from the Contractor's License Law for the following °
• reason:, (Sec. 7031.5,Businass 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 I
requires the applicant for such permit to rile a signed statement that he islicensed pursuant to .PERMIT - AMOUNT
the provisions of, the Contractor's License law, Chapter 9 (commencing with Section 7000) of
Division 3 o/ the Business and Professions Code• or that. he is exempt therefrom, and the basis
/or the alleged exemption. Any .violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500) , plan Chk. Bal:
"9.1.1, 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 Const.
Professions Code: The Contractor's. License Law does not apply to an owner o/ 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 improve for the purpose o/ sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 30.00
struct the project: (Sec. 7044, Business and .Professions Code: The Contractor's License Law .
does not apply to an owner o/ property who builds or improves thereon, and who contracts- /or - S.M.1.
such projectswitha contractor(s) jicensed pursuant to the Contractor's License Law.)
'Grading
O 1 am exempt under Sec ` B. & P.C. for this reason
Driveway Enc.
" Infrastructure
. 0ate .. S r`i Owner. ` c
WORKERS' COMPENSATION DECLARATION f
I hereby affiim 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 30.00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is /or 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'tiecome sublet the Workers' Compensation
Laws of California
t% tet i '� Owner.
NOTICE TO APPLICANT: ff, alter—m—Wng tRrs—CertiBcate of—Exemption. you should become ZONE: BY:
subject to the Workers' Compensation provisions o/ the Labor Code, -you must forthwith
comply with such provisions or this permit shah be deemed revoked. Minimum Setback Distances:
- Front Setback from Center e -
Rear Setback from Rear -r LineN
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side, Street Setback fro nter e.
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 fromP/f erty Line v
DAMAGES AS PROVIDED FOR IN SECTION 3706.OF THE LABOR CODE, INTEREST, AND.,, / L/ j)kA
ATTORNEY'S FEES. // W I
' This is a building permit when properly filled out, signed and validated, and -is subject to FINAL DATE INCTOR + 9
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 • �Pefmit e)
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-.. �J
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
i Mailing Address Validation: r
City, State, Zip
i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL. SO. FT.
SLAB GRADE
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
STORAGE TANK
FORMS
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. I SO. FT.
GAS (ROUGH)
WALL SO. FT.
DRINKING FOUNTAIN
SO. FT. ®
REINF. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
TEMP. POLE
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
I
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
I
LAUNDRYTRAY
AIR HANDLING UNIT CFM
LUMBER GR.
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
FIREPLACE
SO.FT.GAR ® 3/ic
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
GAR. FIREWALL
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. f /r4,�4-
ROOFING
/ �S
//�
REMARKS:
VENTILATION VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL