15596 (BLCK)oil
P.O. BOX 1504
Building -s R
78-495 CALLE TAMPICO
'Address 48-760 San Vicente LA QUINTA, CALIFORNIA 92253
Owner
7T.A-
BUILDING: TYPE CONST.
Mailing Az:
Address GaMe ils above.,",'" ~_
A.P• Number
City
Zip Tel.
uinta"
92253 Legal Description
. I I I
La Q
Contractoreibtion
1Proiect De 4 -
City Zip Tel.:
La Quinta 92253 564-6478
State Lic. , '. ;�: City
& Classif.. 397830 - Lic. # 1375 -
-- Arch., Engr:,
Designer
Address Tel.
City Zip State
f. Lic. #
LICENSED C6NTRACTOR'S DECLARATION
I hereby affirm tj6t+a.!�iqqnsed-under ProvisionspkDtirpter 9 (commencing with Section
7000) of Division -3'6f theBal&ss and P�pf sO� 0 IMAse4
�InW 7pqe,,ancI m Ii A.JW"&,and
effect..
SIGI DATE
OWNEWBUILDER DECLARATION
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
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 five hundred dollars ($500).
0 I, as owner of the property, or my employees with wages as their sole compensation, will'
the he work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or hnproves thereon and who does such work himself or through his own employees,
provided that such improvementsare 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 inprove for the purpose of sale.)
0 1, 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 contractors) licensed pursuant to the Contractor's License Law.)
0 1 am exempt und6r Sec. _13. & P.C. for this reason
No. 15596
GRP.
ne. 'Rewire -existinc
Ad 121f of 64 q4rd(
latwork .
Sq. Ft.
Size
of
Electric
wall. and misc. . , , .
Stories Units
New 0 Add.0 = Alter Repair 0
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech..
Electrical
Plumbing
S.M.L•
Grading
Driveway Eric.
0191000.00
Demolition -0
Al
AMOUNT
Rosa
Date �._Ovvner
infrastructure
WORKERS? COMPENSATION DECLARATION
A I
I hereby affirm'that I have a certificate of consent to self -insure, or a certificate of
Worker Insurance, or a certified copy thereof. (Sec. 3800, LaborCode.)
Cop6sation
Poll Company
's
UVC-opy Is filed with the city.. 0 Certified copy Is hereby furnished.
TOTAL I Q_ _1
CERTIFICATE OF EXEMPTION FROM
REMARKS,
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit Is for one hundred dollars (S 100). valuation
or less.)
I certify that in the performance of thp work for which this permit is issued, I shall not
employ any In any manner so as to become subject to the Workers' Compensation
Law. of California
0 n
Date Owner
NOTICE TO APPLICANT. N, 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 Setb.ackJrom.RearzProp.- Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND -
173 1
, ' Side Setback ®rdrin 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 _9–etba6k firo, IT, -PA `p3,erty-Line
DAMAGES AS PROVIDED FOR IN SECTION' 3706 OF THE LABOR CODE.- INTEREST, AND -
ATTORNEYS FEES.
FINAL DATE—
This Is a building Perm it when properly. filled out, signed and validated, and is subject to
—INSPECTOR
JUL ii
expiration it work thereunder is suspended for -180 days.
II -
I certify that I have read this *application and state that the above information is correct.
Issued by:Date Permit
I agree to comply with all city and county ordinances and slate laws relating -to building
construction, and hereby authorize representatives of this city to -enter the above-,*
mentioned for inspection,
property purposes.
Validated by:
Signature of applicant Date
Mailing Address.
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. S0. FT.
WALL SD. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AU.TO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11A c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING 93
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION 9�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESJINITIALS
GARDEN WALL FINAL