15713 (SFD)P.O. BOX 1504
Buildingi 78-495 CALLE TAMPICO
Address 79-3-335 Briarweod LA QUINTA, CALIFORNIA 92253
Mailing
Addressp.0, BOX 1716
City Zip Tel.
La Quilita 1 92253 771-x1.341
Contractor
Cons-truction
Address
»:O. Box 2716
City Zip Tel.:
?ala QuInta 92253 771-1941
State Lic. City
& Classif. 674074' Lic. # 2996
Arch., Engr.,. ,
Designer l a s ling and McCallum.
Address Tel.
45-13.� Club Drive 360-0250
1 City " Zip State
:..Indian wis ils- 92210 Lic. # ' 07424
LICENSED CONTRACTOR'S DECLARATION
I hereby afi,km that I am licensed under provisions of Chapter 9 commencing with Section
7000, of Division 3 of'the Business and Professions Code, andr license is in full force and
effect .�+�R.. , r.
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;Sustness 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 rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
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
' subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
I, ❑ 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
I Professions Code: -The Contiactor's. License Law does not apply to an owner of property who
builds or improves thereon andwhodoes such work himself or through his own employees,
Pro
vided 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 knprove for the purpose or sale.)
❑ 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
does not apply to an owner of property who builds or improves thereon, and who -contracts for
such projects with a contractor(s) [censed 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
fJPeoopy Is filed with the city, . O Certified copy..is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 the work for which this permit is issued, I shall not
employ anyperson in any manner so as to become subject to the Workers'. Compensation
Laws of California
Date Owner "
NOTICE TO APPLICANT: ff, 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
4 expiration it work thereunder is suspended for 180 days. - .
_ 1 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 inspectiompurposes.- .
Signature of applicant Date
Mailing Address
City, State, Zip -
No. 15713
UILDING:- TYPE CONST. V"14 OCC: GRP. R3
.P. Number 769-760-,018
egal Description Lot 20 Trash 26524
roject Description SFD'
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:
Validated
Validation
Sq. Ft.
Size 4100
No.
Stories
No. Dw.
Units
Newt] Add ❑
. Alter ❑
Repair ❑ Demolition 0
Permit doeA
not include
block wall
or pool.
Estimated Valuation
X33962.
I
PERMIT
AMOUNT
Plan Chk. Dep.
�•
Plan Chk- Bal.
977-4
Const.
1479-50
Mech.
1 9
Electrical
Plumbing2
9 9 SA (11
S.M.I.
Grading
20 Inn
Driveway Enc.
Infrastructure
�
n • t;
i L � cxc�z�
a'v . v>✓
TOTAL -
s ` s .
jai: 9
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:
Validated
Validation
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE 0
2ND FL. SO. FT.
'BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
GAS (ROUGH)
[/
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.j�/j
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
ZINAL INSP. �GJ
``
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
FINAL INS/,4,.2 %
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING
/ � 9 9�
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FE=
SMI FEE —t PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBIN�
UNDERGROUND
A.C. LINT
COLL. AREA
SLAB GRADE 0
ROUGH PLUMB.
'BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWE OR
ROUGH WIRING
DUCT V"ORK
ROCK STORAGE
X --FOUND. REINVI
GAS (ROUGH)
[/
METER LOOP
HEATIN13 (FINAL)
OTHER APPJEOUIP.j�/j
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
ZINAL INSP. �GJ
``
BOND BEAM
WATER SYSTEM
FINAL INS/,4,.2 %
elelr� F NAL INS�G
GRADING
cu. yd.
AP
$ plus x$
_$
LUMBER GR.
V FRAMING /
ROOFING
/ � 9 9�
�l0
®/�/ � �%pGy
,/� ! ��,Q�� ' C
'K'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
RING 3y `-
MESH
SULATION/SOUND4�4 ?6
FINISH GRADING
a//(—FINAL INSPECTIO/G�2
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
0