14438 (SATT)a •
44Q
P.O. BOX 1504 No. 14438
Building 49-658 Paseo TaarraZC 78-495 CALLE TAMPICO
Address LA OUINTA, CALIFORNIA 92253..
Owngocger 3neili.enberger & Associates
BUILDING: TYPE CONST. j;y OCC: GRP. R3
Mailin
Address 55-695 Febble 'Beach 646-082-045.
A.P. Number
City Zip Tel. - Lot 71 Trac4- 20052-4
Un Quintap Chi 922.53. (619M7-7767 Legal Description
Contractor Project Description 4FD i�lan 4
Same Lagena . DeL bra Pae
Address
City... Zip Tel.: .
State Lia City
& Classif.. $ 4$$2.34 Lic. # iat8 - Sq. Ft.No.- -
A Size 1562 Stories
No. Dw.
rch., Engr., Cotr�.oS ^- yn fl'Iiart?r Units
Designer . g New ❑ Add ❑ Alter ❑ Repair ❑'-
A aTU25 Charlesworth Dr. Tf 6ii9) 328- 7271
Cy Zip State
-. 8athedraA. Citi s •C.A 92234 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I amrlicensed°under provisions of Chapter 9 (comrt.encin with Section
7000) of Division J of thejBusinessk-an�d`/Professions Code, and my license's i full f fccee an .
. ..effect.'
REMARKS
,
JiLGNATURE 1F 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 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 file 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. AnyL violation of -Section 7031.5 by -'any applicant for a permit.
• subjects the applicant to a civil penalty of not more than Ove 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 Code: The Contractor's License Law does' not appy to an owner of property who
Estimated Valuation 49i
$,9i
t.. PERMIT
Plan Chk. Dep.
Plan Chk. Bal. ,
, Const.
Mech..
'
builds of 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
Electrical
orImprovement is sold within one year of completion, the, owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) .. . - •.
Plumbing
O'I, as owner of the property, am exclusively contracting with licensed contractors to con- •
atruct the project: (Sec. 7044, Business and -Professions Code:. The Contractor's License Law
S.M.I.
does not apply to an owner of property who builds. or improves thereon, and who contracts for
such projects wlthLa contractors) #tensed pursuant to the Contractor's License Law.) - -
O 1 am exempt under Sec. B. & P.C. for this reason
Grading
Driveway Enc.
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL, AND'SldeStreet
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION '
HUNDRED.THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF,COMPENSATION,
Side Setback from PTO y LiDe-
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. 3900, Labor Code.)-
FINAL DATE PECI3R
r �Q�
Policy,No Company
49; 0 is filed with the city, ❑ Certified copy is hereby furnished. .. . .
TOTAL
Y,
-Issued by:. Date &. 4f_ff�it
ch
CERTIFICATE OF EXEMPTION FROM
�y�JrnA
Demolition ❑
37.'00
AMOUNT
J99•.00
62.00
127.25
150.:.00
9',10
20-.00
1 �i .10+ yr0��
.2.€028.08
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed ff 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' Compensation
y�
Laws of California.
Date Owner '
NOTICE TO APPLICANT. ff. after making this Certificate ,of Exemption you should .become
ZONE: ' '' BY:
subject to the Workers' Compensation provisions of the •Labor Code; you must forthwith
comply with such provisions or this permit shall be deemed revoked:
Minimum Setback Distances: - - - -
Front Setback from Center Line' '
Rear Setback•from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL, AND'SldeStreet
Setback ff,O ente'r.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 PTO y LiDe-
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
FINAL DATE PECI3R
r �Q�
This is a building permit when properly filled out, signed and validated, and is subject to -
expiration if work thereunder is suspended for.100.days.
1 certify that I have read this application and state:that the -above information is correct. '..
f agree to comply with all city and county ordinances and state laws relating to building
construction, hereby *to
Y,
-Issued by:. Date &. 4f_ff�it
ch
and authorize representatives of this city enter the. above-,
mentioned property for inspection
�y�JrnA
purposes.
Validated by: F_J
Signature of applicant Date
Malling.Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT. ®'
WALL SQ. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® IVa c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ic
HOUSE SEWER
FINAL INSP.
ROOFING /OXOX/a
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 j 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 ANOUGH
WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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+l
FINAL INSP.
ROOFING /OXOX/a
i�-,�j (ter �
n�-�✓�i%
[ p
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING Z�
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL