14310 (AR)414
P.O. BOX 1504 N o . 14310
Building 49-250 Ave. Fernando 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
fawner Jim Austin
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Description Room Addition
Mailing' Same
Address
i City
La Qtinta,
Zip
92253
Tel. '
775-1519
ContractorProject
East Valley Construction
Address
54-880 Ave. Alvarado
ATTORNEY'S FEES.
"Citlya Quinta, CA
Zip 92253
Tell564-4844
I, I certify that '-have read this application and state that the above information is correct.
State Lic. 296566
& Classif.
City 1962
Lic. # -
Sq. Ft. 280' No. No. Dw.
Size Stories Units
Arch., Engr., - - -
Designer
New ❑ Add. ❑ Alter ❑ Repair -0 Demolition ❑
Address
Tel.
Signature of applicant Date
City
Zip
State
Lic. # • - '"
LICENSED CONTRACTOR'S DECLARATION
I hereby..affir)n 1h 1 I amflicensed under D Isio'ns of Chapter 9 (commencing with Sectiorr •
7000) of Divis'on 3•bf thee''Suusinesls and Proffbssionss.Code, and my license is in full force and
effect. -+- IJG 7.
-
< SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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 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
Division 3 of the Business and Professions Code, or that. he Ii 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 rove hundred dollars.($500).
❑ 1,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 for sale. If, however, the building
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.)
O 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) licensed pursuant to the Contractor's License Law.). .
❑ I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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. .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 (8100) valuation
or less.) -
I certify that in the performance of•thp 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
Laws of California
Date Owner
NOTICE TO APPLICANT., If, 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.
,720.00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
AMOUNT
140.40
216.00
21.00
22.28
.00
2.07
Grading
Driveway Enc.
Infrastructure
TOTAL 4151.75
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from
Rear Setback frorn�
I Street •t
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
"SUBJECT
$ de $ eet SetbaC
SHALL AN EMPLOYER TO CRIMINAL .PENALTIES -AND CIVIL FINES UP TO ONE
- 7
.. HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
Side Setback ffrr
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
FINAL DATE
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.
nIN:
Q
I, I certify that '-have read this application and state that the above information is correct.
-issued by: Date,
i 1 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:
i mentioned property for inspection purposes. _
Validated by:
Signature of applicant Date
Malling,Address
Validation:
City, State, Zip
Line
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
SEWER OR SEPTIC TANK
ROUGH WIRING
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I S0. FT.
HEATING (FINAL)
OTHER APP./EQUIP.
WALL SQ. FT.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
LATHING
PERMIT FEE
PERMIT FEE
ff
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 If D
SEWER OR SEPTIC TANK
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//";Z
C
�i I V
��/� ( G�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
t !!!!
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESJINITIALS
GARDEN WALL FINAL