15777 (RPL)'44
P.O. BOX 1504
BAding 53-235- Ave Juarez 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Mailing' : /�
Address P..O. Bo 1238
.Ci ty Zip Tel.
:La Quinta 92253 564--4€04..
Contractor ,, .
ronel Construction
Address
Sam as above
City' Zip Tel.:
State Lic.•
& Classif. ' . `6341981
Arch., Engr.;
Designer
Address
%.11Ly
Lic. #1
Tel.
No. 15777' .
BUILDING: TYPE CONST. OCC': GRP.-
A.P. Number w74-032-018
Legal Description ' Lot, 10s; Blk 179
Project Description P001:91 X 2,40
Sq. Ft. j
Size
New ❑ Add O!.
City Zip State
Lic. # .
...
LICENSED CONTRACTOR'S DECLARATION.
I hereby afflrm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect:
SIGNATURE DATE
OWNEWBUILDER DECLARATION E
'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 ,qr county • which requires a
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
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 civil penalty of not more than five hundred dollars.($500). -
O'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 provingthat he did not build or improve for thepurpose or 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,contractsfor.
such projects with'a contractors) licensed pursuant to the Contractor's License Law.) -
❑ 1•am.exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATIONDECLARATION
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
-0 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 any person in any manner so,as'to become subject,to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: 8, after making this Certificate or 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 l have read this application and state that•the.above information is correct:..
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-.
mentioned property for Inspection purposes. ;
Signatureof applicant Date
Mailing, Address
City, State, Zip
No. No. Dw.
-Stories Units .
Alter ❑ Repair
stimated Valuatio$7,000..00
PERMIT. .
Plan Chk.;-Dep.
Plan Chk. Bal.
Const.
S.M.I.
Grading
Driveway Enc.
`Infrastructure
TOTAL
REMARKS r.
❑ -Demolition ❑
' 'i. r 4 t,,'t : t Ii A ;f
.ZONE:
BY:I?
Minimum Setback
Distances:. .
Front Setback from Center Line
Rear Setback from Rear;Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit -
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWQ FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL.SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM j
POR. SO. FT. ®.
MOBILEHOME SVC.
BAR SINK ty
GAR. SO. FT. ®
POWER OUTLET
IROOF DRAINS
ROUGH WIRING
DUCTWORK
DRAINAGE PIPING
,CAR P. SD. FT.
GAS (ROUGH)
WALL SO. FT. ®'
HEATING (FINAL)
DRINKING FOUNTAIN.
SO. FT. ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
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, TEMIPERM
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 ® 1 Va c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAR. FIREWALL
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 / e HEATING & AIR COND. SOLAR
a �a
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH).
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCTWORK
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:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL _ -
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL