15334 (RPL)A _
P •
Building
Address s3i�
T4'ht
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Montezuma Osete Corp. �
Address 45000 club Dr
City Zip Tel.
Contractor
Double 'DO Conatruct3c z
Address .
51-9=60 Ave Herrera
City ZipTel.:
La, QuiAl;a .: � .�2ZS� 1 7'i1'"256I
State Lic.- City
& Classif. 681012 Lic. # 323
Arch:, Engr., .
Designer
Address Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) t.of Division 3 of the Business and Professions Code, and my license is in full force and
effec
SIGNATURE DATE
OWNEWBUILDER DECLARATION
1 hereby affirm that I 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, prfor, to its issuance also
requires the applicant for such permit to We 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 civilpenalty of not more than five hundred dollars ($500).
❑ I, 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
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not bulkd or improve for the purpose of sale.)
❑ 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) Ocensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date 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 B the permit Is for one hundred dollars (5100) valuation
'or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any parson in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT.- It, 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 If work thereunder is suspended for 160 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-.-
mentloned property for inspection purposes.
Signature of applicant -Date-
Mailing
ateMailing Address
City, State, Zip
WING: TYPE CONST
Number
Legal Description
Project Description local 'Q" S'pA.
No. 15334
OCC: GRP.
■
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear ro Line
Side Street Setback fv Cente ine
Side Setback from perty in
'I
FINAL DATE INSPEOR
Issued by:
Validated bv:
Validation: \\ t/f
Sq. Ft. No.
Size - Stories
No. Dw.
Units
New ❑ Add ❑ . Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation $9,000.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
S 76.05
Const.
$117.06
Mech.
S 24.00
Electrical
S 45.00
Plumbing
27.,00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
$289.05
.REMARKS
■
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear ro Line
Side Street Setback fv Cente ine
Side Setback from perty in
'I
FINAL DATE INSPEOR
Issued by:
Validated bv:
Validation: \\ t/f
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB. • If
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SD. FT.
GAS (ROUGH) /l/
DRINKING FOUNTAIN. ,
SQ. FT. ®
HEATING (FINAL),
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER. •
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING.
cu. yd.
$ plus x$
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1✓a c
SEWAGE DISPOSAL
SO.FT.GAR p 3/ec
HOUSE SEWER
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 PLUMBIN.
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. • If
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH) /l/
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:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
'
FENCE FINAL -
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL