15233 (SFD)y P.O. BOX 1504 No. 1,5233
i Building �;r 78-495 CALLE TAMPICO
Address i 4""dS5 Ave • Bermudas LA OUINTA, CALIFORNIA 92253
Owner
I Michael. Dietrick
Mailing
Address -.
City Zip Tel.
Contractor
nstruction
Address
Same
City Zip Tel.:
State LiCity
& Classifc. ..B. 6'$� Lic. # 323 •
Arch:, Engr.:.. ;
"Designer
rAddress Tel.
CityZip State
Lic. # .
LICENSED. CONTRACTOR'S DECLARATION
I hereby affirm that Imam licensed under provisions of Chapter;,9 (commencing with Section
" 7000) of Division 3 of the Business and Professions Code,/�andmmy license is in full force and
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,Business and.Protessions Code: Any city or county which requires a
permit to construct, after,.improve, demolish; or repair any structure, priortoits issuance also
requires the applicant for such permit to rite a signed statement that he is licensed pursuant to
the provisions of the Contractor's License law, Chapter 9 (commencing with Section 7000) of
Division3 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
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
.O 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 Coder 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,
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
. of proving that he did not build or onprove for the purpose of sale.)
D I, 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
1 does not apply .to an owner of property -who builds or improves thereon, and who contracts for
such projects with'a contractors) #tensed pursuant to the Contractor's License Law.)
{' O 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 CoWpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.).
Poly No Company
ryJ Copy is filed with the city, O Certified copy is hereby furnished.
3 `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 the'work for which this permit is issued, I shall not
employ any pperson 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. the Workers' Compensation 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. ($100.000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706,OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application'and state that'the above Information is correct:
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives .,of. this • city to enter the ' above•.'
mentioned property for inspection purposes.
Signature of applicant Date'
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. N OCC: GRP. • `3
A.P. Number
774-285-014
Legal Description Lot 6 Block 302,
SFD
Project Description'
Sq. Ft.No. No. Dw.
Size- Stories Units j.
New ❑ Add O Alter ❑ Repair ❑
-Demolition ❑
PE°=i$ doe s -: udt include
block walla
or pool.
ZONE:
BY:
Estimated Valuation 494,.136.20
PERMIT
AMOUNT ' ,
Plan Chk."Dep:.•. _... 25040
Plan Chk. Bal.
269.48
Const..
6.17..00
Mech.
0
'Electrical
-A26 -29 .
Plur>;lbing
138.00
S.M.I.
s.1
Grading. <_
2040
Driveway Enc.
A0
Infrastructure
2, 064.,20
Pre-cise Plan
25.00
TOTAL -1-3,568-.38
3,318.38
REMARKS -
ZONE:
BY:
Minimum Setback Distances:
- Front Setback from.Center Line
Rear Setback from Rear Prop. Line `
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
'Issued by:
.
Per I
Date ;i
.. .il
..Validated by:
Validation:
I.
h
i
ltal_ 20 1995 C,:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBiW Fr-ES�
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
1ST FL. SO. FT. @ $
UNITS
STORAGE TANK
��•
SEW OR
ROUGH WIRING
YARD SPKLR SYSTEM
ROCK STORAGE
2ND FL. SO. FT. @
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
TEMP. POLE
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
WATER HEATER
CAR P. SO. FT. @
FINAL INSP.
DRAINAGE PIPING
BOND BEAM
WALL SO. FT. @
DRINKING FOUNTAIN
_$
SO. FT. @
URINAL
FRAMING�yj j3/!
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
/�
10479VENTILATION
dpi l/ow
ell—
NOTE: Not to be used as property tax valuation
REMARKS:
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
SPARK ARRESTOR
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SO. FT. @ c
BATH TUB
FENCE FINAL
SO. FT. @ c
WATER HEATER
INSPECTOR'S SIGNATURES/INITIALS
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/. 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 �S
GROUND PLU 9
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEW OR
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. QP
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL 9�
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING�yj j3/!
FINAL INSP.
ROOFING
/�
10479VENTILATION
dpi l/ow
ell—
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL