15164 (RER)TAtyl'
.44
P.O. BOX 1504 No. 15164 "!
kluilding�� 78-495 CALLE TAMPICO -
Address 33" 12-Q - A,�en da Juarez LA QUINTA, CALIFORNIA 92253
•..Owner . .
M£3YRtfs21,ima Oeste . Inc. BUILDING: TYPE -CONST.
MailingOCC: GRP.
" �, Wig; r� � � '
Address�j A.P. Number 774-041--006.
CityZip Tel.
iIES�.'a fixe y Legal Description
Contractor. . . - . . - • 'Rem461' and refurbish
. .. � . to ' Project Description
bo'ubl� D. _ Co.nstructioia.
Address... eY1Stf:ng home
Nirrere
Clic _ Zip Tel::
1 �Ufir 92253' 771-1561 .
State Lic. City
8" )-�Ssif.. 6�. +� Lic. # `.323 Sq. Ft.I530No No. Dw.
Size Stories. ` -Units-
Endr.,
'Design.er eDemohtlon.OE
Address Tel.
4
City 171p State
Lic. # .
77.
"LICENSED CONTRACTOR'S DECLARATION .
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
.7 000) of Division 3 of the Business and Professions Code, and my -license is in full force:and
effect..
SIGNATURE 'DATE , -
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for'the followingEstimatedV" - .aluation .� I B! 000p
. 00
reason: (Sec. ' 7031.5,8usiness. 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'forsuch permit to lite 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) o/ -
Division 3 o/ the Business and Prolessions Code,, or that. he: is exempt. therelroin, and the basis for the alleged .ezemptlon.'Any violation of Section 7031.5 -by -'any applicant, for a perms Plan Chk. Dep.- .•
• subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). .. .. -
0.1, as owner of'the property, or my employees with wages as their sole compensation, will Plan Chk Bal. 248.3p
do the work, and'the structure is not intended or offered. for sale. (Sec. 7044, Buisness and.. Const. 382.L.00—
Professions Code: The. Contractor's license law. does not apply -to an owner of property who {
builds or imp Vag 'Hereon .and, who does such work himself or through his own employees, Mech. - its q/�ua - .-
provided that such.Improvements. are not Intended. or offered lorsale. ll, However, the building• .b:J. V iJ
- or improvement.is sold within one year o/ completion, the owner-6411der will have the. burden Electrical
of proving Hathe did not build or Improve for He purpose o/ sale.) .. ��
O'l, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing r 39.00
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.1:Q
such projects with a contractor(s) jlcensed pursuant to the Contractor's license Law.) -
Grading
❑ 1 am.exempt under, Sec B. 8 P.C. for this reason
Driveway Enc.
Date owner. Infrastructure -
WORKERS' COMPENSATION DECLARATION a
1 hereby affirm thaLl haver' 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
O Copy Is filed with the city, O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
section need 'not be, c "
(This _ ompleted it the permit !s /or one hundred dollars (8100) valuation , • , ,�. ,(� . , pj..,,,• - or less.)
- }• t 1
I certify that In the performance of the work for which this permit is issued, I shall not r �E. y 1
employ any personin any manner so as to become subject to the Workers' Compensation — -
Laws_ of California V
Dai
e Owner
NOTICE, TO APPLICANT: N, aftermakingthis Certificate of. Exemption you -'should become `.
-ZONE;
�. BY -
subject to the Workers' Compensation provisions . of the '.Labor Code, you -must /orthwfH
comply with such provisions orHfspermit shall be deemed revoked.
-
<Minimum Setback Distances: - - -
•
Front Setback from Center Line
•
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Setback from 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 Setback from Property. Line
DAMAGES AS PROVIDED FOR IN' SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when' piopedy filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
expiration if work 4hereunder is suspended for 180 days.
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 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, Zlp
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES.
IST FL. SQ. FT. @ $
2ND FL. SQ. FT.
POR. SO. FT. @
GAR. SO. FT, @
CARP. SQ. 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
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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
BOND BEAM
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
FRAMING -711 � 9�
SO.FT.GAR @ 3/4c
HOUSE SEWER
xr
�w -
X�4,/�/�
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE' PL:CK.FEE
CONST. FEE JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBINJ.UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWE RSE ROUGH WIRING
DUCTWORK
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 -711 � 9�
FINAL INSP.
ROOFING
xr
�w -
X�4,/�/�
REMARKS:
VENTILATION
Lt�' W,04IV10171-�.r
4
faom r
/
FIRE ZONE ROOFING
azex4w
*q awft ��4-9 A
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL