14366 (RR)Building
Address
t44
P.O. BOX 1504 N o . 14366
Z—$ 43�%e•tlare 78-495CALLETAMPICO
LA OU1NTA, CALIFORNIA 92253
R4:3d Si31712: ,
Sa3Ifie ]BUILDING: TYPE CONST. OCC: GRP
Mailing.
Address
city La Qtl� nta, dA Zip 92253
Contractor
Driver -Eddy Const. CO.
Ar�42dOV34 Velie Way #'I .
Desert,4�'p 92.:60
State Lic. B` 122002
& Classif... -
Arch.,'Engr.,.
' D"esigner.
Address
Tel.
Lic. #
Tel.
68-5843
City (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION..
I hereby affirm that.l am llcensed under provisions of Chapter.9 (commencing with Section
000) of DWsion 3 of the Business Professions Code, and my license is in full force and
ffect. (� „�....... .... // A?
SIGNATURE r. DATE
OWNER -BUILDER DECLARATION. "
I hereby affirm that I am exempt from the Contractor's. License Law for the. following
reason:.(Sec. 70al.5,Business and Professions Code: Any city or county which requires a -
A.P. Number
Legal Description
Project Description Replace damaged rQol-sheating
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation V,000. 00
permit to construct, alter, 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 ..
..PERMIT
- - AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Buslness and Professions Code, or that. he Is. exempt therefrom,. and the. basis
for the Any Section 7031.5 /or
Plan Chk. Dep.
alleged exemption. violation of by.'any applicant a permit
subjects the'applicant to a civil penalty o/ not more than five hundred dollars ($500).
O I, as owner of the property, or my employees -with wages.as .their sole compensation; will
Plan Chk. Bal.
_
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness.and
COr1St
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,
Mech:
prodded that such Improvements are not Intended or offered /or sale. If, .however, the building
-
-
or Improvement is sold within one year o/ completion, the owner -builder will have the burden
' Electrical
-
of proving that he did not build or 6nprove for the purpose or sale.)
-
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
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
S.M.I.
such projects with contractors) jrcensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
- Date owner
Infrastructure
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 �NN%. Company
&&Copy is filed with the city, O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N 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 any pparson in any manner so as to become subject to the Workers' Compensation
Laws of California.
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.
Minimurh Setback Distances:
Front Setback from Center Line
Rear Setback from Rear o Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL, ANDSide
StreetSetbaCkfr/ me ine
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 Pr y Line
DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES. FINAL DATE N ECT
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. s /
I certify that I have read this application and state that the above information is correct.. Issued by: Date 1 Bf�Tllt
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
n !v
CONSTRUCTION ESTIMATE
" NO. ELECTRICAL FEES
NO. PLUMBINv FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. p
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. 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
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) -
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR - SUSPENDED
OTHER APPJEOUIP.
LAUNDRY.TRAY
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 ® 11/e c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS: y
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 8 -AIR COND. SOLAR
SETBACK
i
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
' SLAB GRADE -
I-V
ROUGH PLUMB.
BONDING
4.
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGHWIRING
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
FINAL INSP.
ROOFING
REMARKS: y
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
.
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL