15332 (RPL)/
P.O. BOX 1504
Bujl'ding 78-495 CALLE TAMPICO
Address 79-875 SANITA PDDR LA QUINTA, CALIFORNIA 92253
owner
BRIAN. X BPAVRS
Mailing
Address 78-875 SANITA DR
• City LQ
Zip 9225: 1Tel34S®
Contractor
OWNER BUILIDER
Address
78-875 SITA DR
t City Zip Tel.:
.LQ 92253 345-3399
State Lic. City
& Classif. I Lic. #
-Arcn., tngr., I
Designer
Address Tel.
City (Zip( State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION .
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) tof Division 3 of the Business and Professions Code, and my license is in full force and
effec.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
,reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
y -,'permit to construct, alter, 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 �pogisions o/ the Contracror's license Law, Chapter 9 (commencing with Section 7000) o/
Divis)on 3 o/'the, Business and Professions Code, or Iha, he fs exempt therefrom, and the basis
/or the alleged exemption. Any vb/atan o/ Section 7031.5 Dy 'any applicant for a perml
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
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 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 /or 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 bnprove for the purpose o/ sale.)
I, as owner of the property, am exclusively contracting with licensed contractors to con-
- s ucl 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
such projects with a contractors) pcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B! & P.C. for this reason
Date / ? jg' r ? 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
❑ Copy is filed with the city. ❑ 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 thg work for which this permit is issued, I shall not
employ anyparson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: d, 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 it 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
No. 15332
BUILDING: TYPE CONST. .00C: GRP.
Number
Legal Description
Project Description POOL & SPA
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 131 000 ° 00
i
PER AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. �� •
Const. °
Mech. e
00
Electrical MOO
Plumbing 2 7. Ota
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL 33.60'
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center -Line
Rear Setback from Rear r p
Side Street Setback'f•fi'f Cent\e
Side Setback froth Property�Ltrs
FINAL DATE �G INSPECTOR
Issued by: Date\
Validated by:
Validation:
0
CONSTRUCTION ESTIMATE
NO. �' ELECTRICAL FEES
NO. PLUMBING. FEES
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
ROUGH PLUMB. I.
I IV
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
VA
SEWER OR SEPTI AN
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
GAS (ROUGH)
METER LOOP
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. @
GROUT
WATER HEATER
WALL SO. FT. @
FINAL INSP.
DRINKING FOUNTAIN.
SO. FT. @
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
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
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
FINISH GRADING
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 PLUMBINT
UNDERGROUNDA.C.
UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. I.
I IV
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
VA
SEWER OR SEPTI AN
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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.
ROOFING
O /611(
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.q1
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL