15079 (BLCK)P.O. BOX 1504 N o • 15079 -
Building 78-495 CALLE TAMPICO'
Address 54-885 Ave. Juarez LA QUINTA, CALIFORNIA 92253
Owner Eric Mpfcowsky
M .I.
BUILDING: TYPE CONST. OCC: GRP.-
al Ing
Address mill[
City
Zip
Tel.
La Quinta, CA
92253.
1
Contractor
Ialit Stove s€ansy
Adds Box 1333
CityZip
Laa QuintaI CA
i
92.253
Tel.:
564--2228.
State Lic.
City
& Classif.. 0-29 494257
Lic. # 1228
Arch., Engr:,-
Designer
Address
Tel.
City Zip State
Lic- #
LICENSED CONTRACTOR'S DECLARATION.
1 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
` OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bustness 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 rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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 riot more than rive 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
or Improvement 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.)
❑ 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 contractors) licensed 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 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 filedwith 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 the 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., ff, 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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 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-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
A.P. Number
Legal Description_
Project Description
401 of 5''
high garden wall
Sq. Ft.
Size
No.
Stories
No. Dw. ~ r�
.'Units
New ❑ Add ❑
. Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$866.00
I
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal
Const.
25, 00
Mech.
Electrical
Plumbing-
S.M.I.
Grading
Driveway Enc.
� y
Infrastructure
'
TOTAL
" '
25.00
REMARKS
ZONE: BY:
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: I
APR 2 6 1995^j
• r .. I,
By-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE .
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
v
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO. FT.
OTHER APPJEOUIP.
REINF. STEEL
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SQ. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation .
WATER SYSTEM
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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 GOND. SOLAR
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
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
1/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL'FINAL
CITY OF I -A 0�11 HN7A
BUILDING 3:
AND ALL XPPiLL'41,,`
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BUILDING DEPARTMENT
,CITY OF LA QUINTA
OFFICE: (619) 77777012 INSPECTION REQUESTS: (619) 777-7153
TO: DATE: y�
ADDRESS:
PERMIT NO.
CORRECTION NOTICE
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A,07-
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